Circulating acetoacetate is associated with poor prognosis in heart failure patients
Circulating acetoacetate is associated with poor prognosis in heart failure patients
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DOI：
10.1016/j.ijcha.2019.100432
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发表时间：
2019-12-01
影响因子：
2.9
通讯作者：
Takeishi, Yasuchika
中科院分区：
文献类型：
--
作者：
Yokokawa, Tetsuro;Yoshihisa, Akiomi;Takeishi, Yasuchika
背景：乙酰乙酸酯在心脏中是一种替代能源，具有改善心功能的潜力。然而，乙酰乙酸酯对心力衰竭预后的影响尚未被研究。方法：这项研究纳入了连续615名心力衰竭住院患者。结果：根据血醋酸值将心衰患者分为两组(高组：乙酰醋酸组=35mU/L，n=313；低组：乙酰醋酸组=35mU/L，n=302)。与低血压组相比，高血压组的年龄更大(68岁比65岁，P=0.003)，脑利钠肽水平也更高(2.43vs.2.23，P<；0.001)。相比之下，两组患者的糖尿病、慢性肾脏疾病和贫血等并存疾病的患病率没有显著差异。在328天的中位随访期内，发生了66例全因死亡。高分组预后较低分组差(对数等级，P=0.041)。在COX比例风险分析中，循环乙酰乙酸酯水平(每10亩摩尔/L增加)与全因死亡率相关(危险比1.020，95%可信区间1.010-1.030，P<；0.001)。结论：循环乙酰乙酸酯水平与心力衰竭患者全因死亡率有关。这些结果为心力衰竭患者心脏代谢变化的作用提供了新的见解，并提高了乙酰乙酸酯作为一种新的生物标志物预测心力衰竭患者预后的可能性。(C)2019年提交人。爱思唯尔出版公司(Elsevier B.V.)
Background: Acetoacetate is used as an alternative energy source in the heart, and has the potential to improve cardiac function. However, the prognostic impact of acetoacetate has not been investigated in heart failure.Methods: This study enrolled consecutive 615 hospitalized patients with heart failure. We investigated the associations between circulating acetoacetate and clinical characteristics or prognosis in HF patients.Results: We divided the patients into two groups based on circulating acetoacetate levels (high group: acetoacetate >= 35 mu moL/L, n = 313; and low group: acetoacetate >= 35 mu moL/L, n = 302). The high group had an older age (68 vs. 65 years, P = 0.003) and higher log brain natriuretic peptide levels (2.43 vs. 2.23, P < 0.001) compared with the low group. In contrast, there were no significant differences in the prevalence of co-morbidities, including diabetes mellitus, chronic kidney disease, and anemia, between the two groups. During the median follow-up period of 328 days, 66 all-cause deaths occurred. The high group had a worse prognosis compared with the low group (Log rank, P = 0.041). In the Cox proportional hazard analysis, circulating acetoacetate levels (per 10 mu moL/L, increase) were associated with all-cause mortality (hazard ratio 1.020, 95% confidence interval 1.010-1.030, P < 0.001).Conclusions: Circulating acetoacetate is associated with all-cause mortality in patients with heart failure. These results provide new insights into the role of alternative cardiac metabolism in heart failure patients, and raise the possibility of acetoacetate as a novel biomarker to predict the prognosis of heart failure patients. (C) 2019 The Authors. Published by Elsevier B.V.