Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 9, Number 2, April 2018, pages 83-89

Clinical Significance of Skin Autofluorescence in Patients With Type 2 Diabetes Mellitus With Chronic Heart Failure

Figure 1. Comparisons of skin AF values between patients with and without history of heart failure admission. The skin AF levels in patients with a history of hospitalization due to HF were significantly higher than those without a history of hospitalization due to HF (3.0 ± 0.5 AU vs. 2.7 ± 0.5 AU, respectively, P < 0.001) even though mean age was similar between the two groups (80 ± 7 years vs. 79 ± 7 years, respectively). *P < 0.001 vs. non-history of HF hospitalization. AF: autofluorescence; HF: heart failure; AU: arbitrary units.

Figure 2. Results of multiple logistic regression analysis of heart failure hospitalization or high hs-cTnT levels. (a) Subordinate factor is heart failure hospitalization. Adjustment factors are hs-cTnT, E/e′, CAVI, d-ROMs test, and age. (b) Subordinate factor is high hs-cTnT levels. High hs-cTnT was defined as hs-cTnT ≥ 0.018 ng/mL. Adjustment factors are E/e′, history of heart failure hospitalization, CAVI, d-ROMs test, and age. *P < 0.05 vs. skin AF ≤ 2.5 AU; **P < 0.01 vs. skin AF ≤ 2.5 AU, ***P < 0.001 vs. skin AF ≤ 2.5 AU. hs-cTnT: high-sensitivity cardiac troponin T; CAVI: cardio-ankle vascular index; d-ROMs: derivatives of reactive oxygen metabolites; AU: arbitrary units.

**Table 1.** Patient Characteristics
Continuous values are mean ± SD. HF: heart failure; HOMA-IR: homeostasis assessment insulin resistance; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
n (male/female)	257 (96/161)
Age (years)	79 ± 7
Skin autofluorescence (AU)	2.8 ± 0.5
Body mass index	22.8 ± 0.6
Current smoker, n (%)	30 (12)
Ischemic heart disease, n (%)	39 (15)
HF hospitalization, n (%)	60 (23)
Hypertension, n (%)	202 (79)
Systolic blood pressure (mm Hg)	139 ± 17
Diastolic blood pressure (mm Hg)	81 ± 10
Dyslipidemia, n (%)	172 (67)
Fasting blood glucose (mg/dL)	143 ± 26
HOMA-IR	2.8 ± 1.8
Hemoglobin A1c (%)	7.3 ± 1.0
Heart valvular disease, n (%)	189 (74)
IVSTd (mm)	9.8 ± 1.8
LVDd (mm)	50.0 ± 3.6
LVEF (%)	68.8 ± 12.8
LAD (mm)	42.5 ± 5.6
E/e′	9.6 ± 3.7
eGFR (mL/min/1.73 m²)	48.4 ± 17.6
Log-BNP (pg/mL)	2.0 ± 0.3
Log-hs-cTnT (ng/mL)	-2.0 ± 0.3
d-ROMs test (U. CARR)	336 ± 108
CAVI	9.7 ± 1.4
Medication
Sulfonylurea, n (%)	186 (72)
Biguanide, n (%)	41 (16)
DPP-4 inhibitor, n (%)	155 (60)
Insulin, n (%)	26 (10)
RAS inhibitor, n (%)	169 (66)
β-blocker, n (%)	56 (22)
Diuretics, n (%)	40 (16)
Statin, n (%)	159 (62)

Table 1. Patient Characteristics

Continuous values are mean ± SD. HF: heart failure; HOMA-IR: homeostasis assessment insulin resistance; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

n (male/female)

257 (96/161)

Age (years)

79 ± 7

Skin autofluorescence (AU)

2.8 ± 0.5

Body mass index

22.8 ± 0.6

Current smoker, n (%)

30 (12)

Ischemic heart disease, n (%)

39 (15)

HF hospitalization, n (%)

60 (23)

Hypertension, n (%)

202 (79)

Systolic blood pressure (mm Hg)

139 ± 17

Diastolic blood pressure (mm Hg)

81 ± 10

Dyslipidemia, n (%)

172 (67)

Fasting blood glucose (mg/dL)

143 ± 26

HOMA-IR

2.8 ± 1.8

Hemoglobin A1c (%)

7.3 ± 1.0

Heart valvular disease, n (%)

189 (74)

IVSTd (mm)

9.8 ± 1.8

LVDd (mm)

50.0 ± 3.6

LVEF (%)

68.8 ± 12.8

LAD (mm)

42.5 ± 5.6

E/e′

9.6 ± 3.7

eGFR (mL/min/1.73 m²)

48.4 ± 17.6

Log-BNP (pg/mL)

2.0 ± 0.3

Log-hs-cTnT (ng/mL)

-2.0 ± 0.3

d-ROMs test (U. CARR)

336 ± 108

CAVI

9.7 ± 1.4

Medication

Sulfonylurea, n (%)

186 (72)

Biguanide, n (%)

41 (16)

DPP-4 inhibitor, n (%)

155 (60)

Insulin, n (%)

26 (10)

RAS inhibitor, n (%)

169 (66)

β-blocker, n (%)

56 (22)

Diuretics, n (%)

40 (16)

Statin, n (%)

159 (62)

**Table 2.** Relationship Between Skin AF and Various Clinical Parameters
	r	P value
r expressed correlation coefficient. HOMA-IR: homeostasis assessment insulin resistance; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	-0.01	0.065
Age	0.12	< 0.05
Body mass index	0.06	0.363
Current smoker (no = 0, yes = 1)	0.12	< 0.05
Ischemic heart disease (no = 0, yes = 1)	0.13	< 0.05
Hypertension (no = 0, yes = 1)	0.03	0.631
Systolic blood pressure	0.09	0.158
Diastolic blood pressure	0.02	0.700
Dyslipidemia (no = 0, yes = 1)	0.04	0.527
Fasting blood glucose	0.05	0.448
HOMA-IR	0.06	0.372
Hemoglobin A1c	0.16	< 0.01
Heart valvular disease (no = 0, yes = 1)	0.05	0.433
IVSTd	0.04	0.523
LVDd	0.03	0.563
LVEF	0.04	0.514
LAD	0.12	< 0.05
E/e′	0.30	< 0.001
eGFR	-0.16	< 0.01
Log-BNP	0.29	< 0.001
Log-hs-cTnT	0.45	< 0.001
d-ROMs test	0.31	< 0.001
CAVI	0.38	< 0.001
Sulfonylurea (no = 0, yes = 1)	0.03	0.684
Biguanide (no = 0, yes = 1)	0.04	0.507
DPP-4 inhibitor (no = 0, yes = 1)	-0.07	0.242
Insulin (no = 0, yes = 1)	0.02	0.811
RAS inhibitor (no = 0, yes = 1)	-0.09	0.158
β-blocker (no = 0, yes = 1)	0.05	0.429
Diuretics (no = 0, yes = 1)	0.03	0.679
Statin (no = 0, yes = 1)	-0.02	0.701

Table 2. Relationship Between Skin AF and Various Clinical Parameters

P value

r expressed correlation coefficient. HOMA-IR: homeostasis assessment insulin resistance; IVSTd: interventricular septal thickness at end-diastole; LVDd: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LAD: left atrial dimension; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

-0.01

0.065

Age

0.12

< 0.05

Body mass index

0.06

0.363

Current smoker (no = 0, yes = 1)

0.12

< 0.05

Ischemic heart disease (no = 0, yes = 1)

0.13

< 0.05

Hypertension (no = 0, yes = 1)

0.03

0.631

Systolic blood pressure

0.09

0.158

Diastolic blood pressure

0.02

0.700

Dyslipidemia (no = 0, yes = 1)

0.04

0.527

Fasting blood glucose

0.05

0.448

HOMA-IR

0.06

0.372

Hemoglobin A1c

0.16

< 0.01

Heart valvular disease (no = 0, yes = 1)

0.05

0.433

IVSTd

0.04

0.523

LVDd

0.03

0.563

LVEF

0.04

0.514

LAD

0.12

< 0.05

E/e′

0.30

< 0.001

eGFR

-0.16

< 0.01

Log-BNP

0.29

< 0.001

Log-hs-cTnT

0.45

< 0.001

d-ROMs test

0.31

< 0.001

CAVI

0.38

< 0.001

Sulfonylurea (no = 0, yes = 1)

0.03

0.684

Biguanide (no = 0, yes = 1)

0.04

0.507

DPP-4 inhibitor (no = 0, yes = 1)

-0.07

0.242

Insulin (no = 0, yes = 1)

0.02

0.811

RAS inhibitor (no = 0, yes = 1)

-0.09

0.158

β-blocker (no = 0, yes = 1)

0.05

0.429

Diuretics (no = 0, yes = 1)

0.03

0.679

Statin (no = 0, yes = 1)

-0.02

0.701

**Table 3.** Multiple Regression Analysis for Skin AF
Explanatory factor	β	P value
R² = 0.31. AF: autofluorescence; hs-cTnT: high-sensitivity cardiac troponin T; CAVI: cardio-ankle vascular index; HF: heart failure; d-ROMs: derivatives of reactive oxygen metabolites; eGFR: estimated glomerular filtration rate; β: standardized regression coefficient; R²: coefficient of determination.
Log-hs-cTnT	0.30	< 0.001
E/e′	0.25	< 0.001
HF hospitalization	0.23	< 0.001
CAVI	0.21	< 0.001
d-ROMs test	0.15	< 0.01
Age	0.13	< 0.05
eGFR	-0.08	0.144

Table 3. Multiple Regression Analysis for Skin AF

Explanatory factor

P value

R² = 0.31. AF: autofluorescence; hs-cTnT: high-sensitivity cardiac troponin T; CAVI: cardio-ankle vascular index; HF: heart failure; d-ROMs: derivatives of reactive oxygen metabolites; eGFR: estimated glomerular filtration rate; β: standardized regression coefficient; R²: coefficient of determination.

Log-hs-cTnT

0.30

< 0.001

E/e′

0.25

< 0.001

HF hospitalization

0.23

< 0.001

CAVI

0.21

< 0.001

d-ROMs test

0.15

< 0.01

Age

0.13

< 0.05

eGFR

-0.08

0.144