Serum Free Fatty Acids Independently Predict Adverse Outcomes in Acute Heart Failure Patients.
Serum Free Fatty Acids Independently Predict Adverse Outcomes in Acute Heart Failure Patients.
复制标题
血清游离脂肪酸独立预测急性心力衰竭患者的不良后果
DOI：
10.3389/fcvm.2021.761537
复制
发表时间：
2021
影响因子：
3.6
通讯作者：
Xiang M
中科院分区：
文献类型：
--
作者：
Yu Y;Jin C;Zhao C;Zhu S;Meng S;Ma H;Wang J;Xiang M
背景：能量代谢紊乱加剧了心功能不全，成为充血性心力衰竭潜在的治疗靶点。尽管循环游离脂肪酸(FFA)与胰岛素抵抗和冠心病风险有关，但循环FFA是否与急性心力衰竭(AHF)患者的预后有关仍不清楚。方法：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183例AHF患者(新发心力衰竭或失代偿性慢性心力衰竭)。调查出院后1年内全因死亡率和心力衰竭(HF)再住院情况。血清游离脂肪酸被建模为四分位数和连续变量(根据游离脂肪酸的标准差)。应用限制三次样条法和COX比例风险模型评估血清游离脂肪酸水平与全因死亡率或心力衰竭再住院之间的关系。结果：在一年的随访中，共有71名患者(38.8%)有全因死亡或心力衰竭再住院。血清游离脂肪酸水平与死亡或心力衰竭再住院的风险呈正相关，而与胰岛素抵抗状态无关。当用限制性三次样条法模拟时，血清游离脂肪酸与死亡或心力衰竭再住院的发生率呈线性增加。在调整了性别、年龄、体重指数、冠心病、糖尿病、高血压、左心室射血分数和N末端脑利钠肽原的多因素分析中，每增加一个标准差(303.07μ摩尔/L)，死亡或心力衰竭再住院的风险增加26%(95%可信区间，2-55%)。每增加四分位数的游离脂肪酸分别与死亡或心力衰竭再住院的风险比增加相关，分别为1(参考)、1.71(95%可信区间，[0.81，3.62])、1.41(95%可信区间，[0.64，3.09])和3.18(95%可信区间，[1.53，6.63])。结论：AHF患者入院时的血清FFA水平与不良结局的风险增加相关。还需要更多的研究来确定游离脂肪酸与急性心功能不全之间的因果关系，以及游离脂肪酸是否可能成为AHF治疗的潜在靶点。
Background: 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). Methods: This single-center, observational cohort study enrolled 183 AHF patients (de novo 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. Results: 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. Conclusion: 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.