Yu Yi, Jin Chunna, Zhao Chengchen, Zhu Shiyu, Meng Simin, Ma Hong, Wang Jian'an, Xiang Meixiang
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Cardiovasc Med. 2021 Dec 22;8:761537. doi: 10.3389/fcvm.2021.761537. eCollection 2021.
Perturbation of energy metabolism exacerbates cardiac dysfunction, serving as a potential therapeutic target in congestive heart failure. Although circulating free fatty acids (FFAs) are linked to insulin resistance and risk of coronary heart disease, it still remains unclear whether circulating FFAs are associated with the prognosis of patients with acute heart failure (AHF). This single-center, observational cohort study enrolled 183 AHF patients ( heart failure or decompensated chronic heart failure) in the Second Affiliated Hospital, Zhejiang University School of Medicine. All-cause mortality and heart failure (HF) rehospitalization within 1 year after discharge were investigated. Serum FFAs were modeled as quartiles as well as a continuous variable (per SD of FFAs). The restricted cubic splines and cox proportional hazards models were applied to evaluate the association between the serum FFAs level and all-cause mortality or HF rehospitalization. During a 1-year follow-up, a total of 71 (38.8%) patients had all-cause mortality or HF rehospitalization. The levels of serum FFAs positively contributed to the risk of death or HF rehospitalization, which was not associated with the status of insulin resistance. When modeled with restricted cubic splines, the serum FFAs increased linearly for the incidence of death or HF rehospitalization. In a multivariable analysis adjusting for sex, age, body-mass index, coronary artery disease, diabetes mellitus, hypertension, left ventricular ejection fraction and N-terminal pro-brain natriuretic peptid, each SD (303.07 μmol/L) higher FFAs were associated with 26% higher risk of death or HF rehospitalization (95% confidence interval, 2-55%). Each increasing quartile of FFAs was associated with differentially elevated hazard ratios for death or HF rehospitalization of 1 (reference), 1.71 (95% confidence interval, [0.81, 3.62]), 1.41 (95% confidence interval, [0.64, 3.09]), and 3.18 (95% confidence interval, [1.53, 6.63]), respectively. Serum FFA levels at admission among patients with AHF were associated with an increased risk of adverse outcomes. Additional studies are needed to determine the causal-effect relationship between FFAs and acute cardiac dysfunction and whether FFAs could be a potential target for AHF management.
能量代谢紊乱会加剧心脏功能障碍，这是充血性心力衰竭潜在的治疗靶点。尽管循环游离脂肪酸（FFA）与胰岛素抵抗及冠心病风险相关，但循环FFA是否与急性心力衰竭（AHF）患者的预后相关仍不清楚。这项单中心观察性队列研究纳入了浙江大学医学院附属第二医院的183例AHF患者（心力衰竭或失代偿性慢性心力衰竭）。对出院后1年内的全因死亡率和心力衰竭（HF）再住院情况进行了调查。血清FFA被建模为四分位数以及连续变量（每标准差FFA）。应用受限立方样条和Cox比例风险模型来评估血清FFA水平与全因死亡率或HF再住院之间的关联。在1年的随访期间，共有71例（38.8%）患者出现全因死亡或HF再住院。血清FFA水平对死亡或HF再住院风险有正向影响，且与胰岛素抵抗状态无关。当用受限立方样条建模时，血清FFA水平对于死亡或HF再住院发生率呈线性增加。在对性别、年龄、体重指数、冠状动脉疾病、糖尿病、高血压、左心室射血分数和N末端脑钠肽前体进行校正的多变量分析中，每升高1个标准差（303.07μmol/L）的FFA与死亡或HF再住院风险高26%相关（95%置信区间，2 - 55%）。FFA每增加一个四分位数，死亡或HF再住院的风险比分别差异升高至1（参考值）、1.71（95%置信区间，[0.81, 3.62]）、1.41（95%置信区间，[0.64, 3.09]）和3.18（95%置信区间，[1.53, 6.63]）。AHF患者入院时的血清FFA水平与不良结局风险增加相关。需要进一步研究来确定FFA与急性心脏功能障碍之间的因果关系，以及FFA是否可能成为AHF治疗的潜在靶点。
