Chen Wei-Siang, Liu Min-Hui, Cheng Mei-Ling, Wang Chao-Hung
Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine.
Healthy Aging Research Center, Chang Gung University.
Int Heart J. 2020 Sep 29;61(5):1014-1021. doi: 10.1536/ihj.20-053. Epub 2020 Sep 2.
Impaired fatty acid metabolism is associated with heart failure (HF) prognosis. However, specific changes in acylcarnitine profiles and their potential clinical value have not been well explored in patients recovering from acute decompensation.This study recruited 79 HF patients hospitalized because of acute decompensation with a left ventricular ejection fraction (LVEF) of < 40% and 51 normal controls. Patients were dichotomized into two groups, namely, the "improved (IMP) " and the "non-improved (NIMP) " groups, as defined by the changes in LVEF from baseline to 12 months after discharge. Mass spectrometry was used to quantify the acylcarnitine concentrations at baseline and 6 and 12 months after discharge. The IMP and NIMP groups contained 42 and 37 patients, respectively. At baseline, HF patients had higher plasma concentrations of specific long-, medium-, and short-chain acylcarnitines compared to normal controls. From baseline to 12 months post-discharge, the IMP group showed significant decreases in long- and short-chain acylcarnitine concentrations, but significant increases in medium-chain acylcarnitines. In the NIMP group, none of the acylcarnitines significantly decreased, and significant increases were noted in long-, medium-, and short-chain acylcarnitines. Generalized estimating equations demonstrated that nine acylcarnitines could discriminate the IMP group from the NIMP group, including three long-chain (C18:1, C16, and C16:1) and six short-chain acylcarnitines (C5, C5-OH, C4, C4:1-DC, C3, and C2). After adjusting for age, the six short-chain acylcarnitines remained significant. Changes in short-chain acylcarnitine profiles are independently associated with the improvement in cardiac systolic function after acute decompensation.
脂肪酸代谢受损与心力衰竭（HF）的预后相关。然而，在急性失代偿恢复过程中的患者中，酰基肉碱谱的具体变化及其潜在的临床价值尚未得到充分研究。本研究招募了79例因急性失代偿住院的HF患者，其左心室射血分数（LVEF）<40%，以及51名正常对照者。根据出院后12个月LVEF相对于基线的变化，将患者分为两组，即“改善（IMP）”组和“未改善（NIMP）”组。采用质谱法对基线时、出院后6个月和12个月时的酰基肉碱浓度进行定量。IMP组和NIMP组分别包含42例和37例患者。在基线时，与正常对照相比，HF患者血浆中特定的长链、中链和短链酰基肉碱浓度更高。从基线到出院后12个月，IMP组的长链和短链酰基肉碱浓度显著下降，但中链酰基肉碱显著增加。在NIMP组中，没有酰基肉碱显著下降，长链、中链和短链酰基肉碱均显著增加。广义估计方程表明，9种酰基肉碱可以区分IMP组和NIMP组，包括3种长链（C18:1、C16和C16:1）和6种短链酰基肉碱（C5、C5-OH、C4、C4:1-DC、C3和C2）。在调整年龄后，6种短链酰基肉碱仍然具有显著性。急性失代偿后，短链酰基肉碱谱的变化与心脏收缩功能的改善独立相关。
