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Erschienen in: Heart and Vessels 7/2021

22.01.2021 | Original Article

Prognostic value of leucine/phenylalanine ratio as an amino acid profile of heart failure

verfasst von: Hiroaki Hiraiwa, Takahiro Okumura, Toru Kondo, Toshiaki Kato, Shingo Kazama, Yuki Kimura, Toshikazu Ishihara, Etsuo Iwata, Masafumi Shimojo, Sayano Kondo, Soichiro Aoki, Yasunori Kanzaki, Daisuke Tanimura, Hiroaki Sano, Yoshifumi Awaji, Sumio Yamada, Toyoaki Murohara

Erschienen in: Heart and Vessels | Ausgabe 7/2021

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Abstract

Heart failure (HF) causes a hypercatabolic state that enhances the catabolic activity of branched-chain amino acids (BCAA; leucine, isoleucine, and valine) in the heart and skeletal muscles and reduces protein synthesis in the liver. Consequently, free plasma aromatic amino acids (AAA, tyrosine and phenylalanine) are increased. To date, we have reported the prognostic value of the BCAA/AAA ratio (Fischer’s ratio) in patients with HF. However, the leucine/phenylalanine ratio, which is a simpler index than the Fischer’s ratio, has not been examined. Therefore, the prognostic value of the leucine/phenylalanine ratio in patients with HF was investigated. Overall 157 consecutive patients hospitalized for worsening HF (81 men, median age 78 years) were enrolled in the study. Plasma amino acid levels were measured when the patients were stabilized at discharge. Cardiac events were defined as a composite of cardiac death and hospitalization for worsening HF. A total of 46 cardiac events occurred during the median follow-up period of 238 (interquartile range 93–365) days. The median leucine/phenylalanine ratio was significantly lower in patients with cardiac events than in those without cardiac events (1.4 vs. 1.8, P < 0.001). The best cutoff value of the leucine/phenylalanine ratio was determined as 1.7 in the receiver operating characteristic (ROC) curve for cardiac events. Following a Kaplan–Meier survival analysis, the low group (leucine/phenylalanine ratio < 1.7, n = 72) had more cardiac events than the high group (leucine/phenylalanine ratio ≥ 1.7, n = 85) (log-rank, P < 0.001). Multivariate Cox proportional hazards regression analysis showed that the leucine/phenylalanine ratio was an independent predictor of cardiac events. Furthermore, on comparing the prognostic values for cardiac events based on ROC curves of leucine levels, BCAA levels, Fischer’s ratio, and leucine/phenylalanine ratio, the leucine/phenylalanine ratio was the most accurate in predicting future cardiac events (area under the curve 0.763,; sensitivity 0.783,; specificity 0.676,; P < 0.001). The leucine/phenylalanine ratio could be a useful predictor of future cardiac events in patients with HF, reflecting an imbalance in amino acid metabolism.
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Metadaten
Titel
Prognostic value of leucine/phenylalanine ratio as an amino acid profile of heart failure
verfasst von
Hiroaki Hiraiwa
Takahiro Okumura
Toru Kondo
Toshiaki Kato
Shingo Kazama
Yuki Kimura
Toshikazu Ishihara
Etsuo Iwata
Masafumi Shimojo
Sayano Kondo
Soichiro Aoki
Yasunori Kanzaki
Daisuke Tanimura
Hiroaki Sano
Yoshifumi Awaji
Sumio Yamada
Toyoaki Murohara
Publikationsdatum
22.01.2021
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 7/2021
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-020-01765-z

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