The energy metabolic changes in heart failure (HF) involve altered fatty acid metabolism. Carnitine is an essential cofactor for fatty acid metabolism. Decreased myocardial carnitine levels and increased plasma carnitine levels in HF have been reported. A plasma acylcarnitine to free carnitine ratio (AC/FC ratio) has been recently recognized as a marker of carnitine deficiency. We investigated the significance of the AC/FC ratio on prognosis of HF and compare its prognostic impact between HF patient with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We analyzed 168 patients with HF who admitted to our hospital. These patients were divided into 3 groups based on the AC/FC ratio: 1st (AC/FC ratio < 0.15, n = 56), 2nd (0.15 < AC/FC ratio < 0.25, n = 56) and 3rd (0.25 < AC/FC ratio, n = 56) tertiles. In the Kaplan-Meier analysis, cardiac event rates progressively increased from 1st to 2nd and 3rd groups (P = .022). When analyzed separately between HFpEF and HFrEF, cardiac event rates progressively increased from 1st to 2nd and 3rd groups in HFpEF (P = .008), but not in HFrEF. In the Cox proportional hazard analysis, the AC/TC ratio was an independent predictor of cardiac event, especially in HFpEF. In conclusion, the AC/TC ratio can identify high risk patients in HFpEF.
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