Evolution and bad prognostic value of advanced glycation end products after acute heart failure: relation with body composition

Abstract

Aim: The role of advanced glycation end products (AGEs) and their soluble receptor (sRAGE) on the progression and prognosis of acute heart failure (HF) was analysed in relation with metabolic parameters as body composition and nutritional status.

Methods: A hundred and fifty consecutive patients were included in a prospective clinical study during hospitalization by acute HF. Detailed medical history, physical examination, electrocardiogram, echocardiogram and vein peripheral blood were taken for all patients. During the follow-up period [297 days (88-422 days)] blood samples for biochemical measurements were obtained 1 and 6 months after the inclusion. Dual-energy X-ray absorptiometry analyses were performed 1 week after discharge.

Results: AGEs and sRAGE levels continuously increased, up to 6 months, after acute HF, but AGEs increase was mainly observed in those patients with incident HF. Both AGEs and sRAGE levels were related with bad renal function and clinical malnutrition (CONUT score) and they were negatively related with body mass index or percentage of body fat. AGEs levels (≥40 a.u.) 1 month after discharge and basal sRAGE levels (>1000 pg/mL) were related with worse prognosis in terms of patient death and HF readmission (Log-rank <0.05 in Kaplan-Meier survival test), independently of age, gender, body mass index and other risk factors. Regression models also corroborated this finding.

Conclusions: AGEs and sRAGE are bad prognostic biomarkers for HF and useful markers of HF progression. Since their levels seem to be related with clinical malnutrition and body composition these parameters could serve to modulate them.

Keywords: Acute heart failure; Advanced glycation end products; Heart failure prognosis; Heart failure progression; Soluble RAGE.

Fig. 1

AGEs (a) and sRAGE (b) plasma levels at time of discharge and after 1 or 6 months. Boxes represent interquartile ranges with median as horizontal line. Vertical bars demarcate the maximum to minimum range. *p <0.05 vs. basal values, # <0.05 vs. 1 month levels, by Wilcoxon test

Fig. 2

Cumulative survival curves during the follow-up period for patients grouped accordingly to the AGE levels at 1 month of discharge (AGE_1m) by the cut-off point of 40 a.u. (a) or by the cut-off point of 1000 pg/mL of basal sRAGE (sRAGE₀) concentration (b). Survival was considered free of death or HF readmission. Kaplan–Meier curves were analysed with log-rank test and their p value is showed