Skin Autofluorescence as a Predictor of First Heart Failure Hospitalization in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Background: An autofluorescence (AF) reader can be used to diagnose skin AF non-invasively by measuring local accumulation of advanced glycation end-products. A number of studies have investigated the relationships between skin AF and cardiovascular disease. However, data regarding the usefulness of skin AF as a predictor of chronic heart failure remain limited. This prospective study aimed to elucidate the usefulness of skin AF as a predictor of first heart failure (HF) hospitalization in patients with HF with preserved ejection fraction (HFpEF).Methods: A total of 412 outpatients with HFpEF with no history of HF hospitalization were enrolled. Patients were assigned to either the low (group L; skin AF ≤ 2.9 arbitrary units (AU); n = 303) or the high (group H; skin AF ≥ 3.0 AU; n = 109) group according to optimal skin AF cut-off levels determined using receiver operating characteristic curves. Clinical parameters and the usefulness of skin AF as a predictor of first HF hospitalization were evaluated. Results:The E/e' ratio as a marker of left ventricular diastolic function was significantly higher in group H patients than in group L patients at baseline (group H, 11.8 ± 3.8; group L, 10.6 ± 3.3; P = 0.002). During the 72.7-month follow-up period, 43 HF cases were hospitalized (group L, 15 cases; group H, 28 cases; P < 0.001, log-rank test). Multivariate Cox regression analyses revealed that group H exhibited a significantly higher risk of first HF hospitalization than did group L (hazard ratio, 2.26; 95% confidence interval, 1.21 -3.52; P = 0.014). Conclusions:The present study demonstrated that skin AF can predict the risk of first HF hospitalization in patients with HFpEF. Prospective studies, including intervention therapies, are required to validate our observations.

Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

“…Waateringe et al reported that, for every unit of SAF increase, the risk of developing CVD increases threefold and the risk of death increases fivefold in a study with 72,880 participants [ 30 ]. Additionally, a study on patients with HF with preserved ejection fraction found that higher SAF levels (SAF > 2.9 AU) were associated with first hospitalization for HF [ 32 ]. Moreover, our teams have recently reported that exercise capacity, a strong predictor in patients with CVD, was significantly lower in patients with higher SAF levels regardless of their DM status and that SAF levels were independently associated with exercise intolerance in patients with CVD [ 9 ].…”

Increased skin autofluorescence of advanced glycation end-products (AGEs) in Tunisian hemodialysis patients with heart failure

“…SAF may be a prognostic factor in patients with long-standing persistent atrial fibrillation and the risk value of SAF was considered as 2.6 AU for high CHADS2 score and SAF value at 2.7AU for elevated high sensitivity cardiac troponin levels [27]. Furthermore, SAF can predict the risk of the first HF hospitalization in patients with preserved ejection fraction and the cut-off point of SAF was determined to be > 2.9 AU [28].…”

Skin Autofluorescence as a Potential Adjunctive Marker for Cardiovascular Risk Assessment in Type 2 Diabetes: A Systematic Review

“…Moreover, in a study by Yoshioka [55], SAF can predict CV risk in patients with T2DM, being correlated with elevated hs-cTnT and NT-proBNP. Another CV risk identified by Hitsumoto [56] is the prediction of the risk of first HF hospitalization in patients with HFpEF.…”