Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan.
Cardiovasc Diabetol. 2021 Oct 16;20(1):208. doi: 10.1186/s12933-021-01398-0.
Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. This study aimed to investigate the associations between SAF and MACE risk in patients with HF who underwent CR.
This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. Major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2017.
Patients' mean age was 68.1 years, and 61% were male. Patients were divided into two groups according to the median SAF levels (High and Low SAF groups). Patients in the High SAF group were significantly older, had a higher prevalence of chronic kidney disease, and more frequently had history of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a mean follow-up period of 590 days, 18 patients had all-cause mortality and 36 were hospitalized for HF. Kaplan-Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P < 0.05). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (odds ratio, 1.86; 95% confidence interval, 1.08-3.12; P = 0.03).
SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who underwent CR.
皮肤荧光（SAF）水平所指示的晚期糖基化终产物可能是糖尿病（DM）和肾病患者全因和心血管死亡率的预后预测指标。然而，在接受心脏康复（CR）的心力衰竭（HF）患者中，SAF 水平的临床实用性尚不清楚。本研究旨在探讨 CR 后 HF 患者的 SAF 水平与 MACE 风险之间的相关性。
本研究纳入了 2015 年 11 月至 2017 年 10 月在我们大学医院接受 CR 的 204 例连续 HF 患者。在 CR 开始时收集临床特征和人体测量数据。使用荧光阅读器无创性测量 SAF 水平。主要不良心血管事件（MACE）是全因死亡率和 HF 计划外住院的综合指标。直到 2017 年 11 月收集有关主要终点的随访数据。
患者的平均年龄为 68.1 岁，61%为男性。根据 SAF 中位数将患者分为两组（高 SAF 组和低 SAF 组）。高 SAF 组患者年龄较大，慢性肾脏病患病率较高，且有冠状动脉旁路移植术史的患者较多；然而，两组间在性别、DM 患病率、左心室射血分数和身体功能方面无显著差异。在平均 590 天的随访期间，18 例患者发生全因死亡，36 例患者因 HF 住院。Kaplan-Meier 分析显示，高 SAF 组患者 MACE 发生率较高（对数秩 P<0.05）。在校正混杂因素后，Cox 回归多变量分析显示 SAF 水平与 MACE 发生率独立相关（优势比，1.86；95%置信区间，1.08-3.12；P=0.03）。
SAF 水平与 HF 患者 MACE 的发生率显著相关，可能对接受 CR 的 HF 患者的危险分层有用。
