Abstract 13593: Lower Plasma Omega-6 Polyunsaturated Fatty Acid Level and Malnutrition in Acute Heart Failure Patients and Its Association With Worse Clinical Outcome

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Backgrounds: Malnutrition was reported to be associated with poor clinical outcome in acute heart failure (AHF) patients. Plasma omega-6 (n-6) polyunsaturated fatty acids (PUFA) were parts of the essential fatty acids absorbed with intestine, and its absorption impairment could occur in right side of heart failure (HF). Thus, we aim to investigate whether the n-6 PUFA level could be a marker for malnutrition and a determinant of prognosis in patients with AHF. Methods: We examined 320 consecutive AHF patients who admitted to our institution between January 2013 and January 2014 from prospective registry. Patients with acute coronary syndrome and without complete data-set at admission were excluded. Finally, 284 patients were divided into two groups according to the plasma n-6 PUFA level as follows; Group A [lower plasma n-6 PUFA (dihomo-gamma-linolenic acid plus arachidonic acid) (below 163 μg/ml, the median), Group B [higher plasma n-6 PUFA (above 163 μg/ml) level] at admission. Adverse events were defined as worsening HF and death. Results: During a mean period of 231 days, adverse events were occurred in 78 patients (27 %). Group A had higher incidence of adverse events compared with group B (35% vs 20%, P<0.01). Group A had lower blood pressure, hemoglobin, plasma omega-3 (n-3) PUFA levels, higher age and serum creatinine level on admission than group B. Regarding right HF sign, group A had higher prevalence of jugular vein distention (P=0.04), hepatomegaly (P<0.01) and higher bilirubin level (P<0.01) than group B. Furthermore, group A had lower serum total cholesterol (P<0.01), triglyceride (P=0.02), and albumin (P<0.01) levels as malnutrition than group B. In multivariate Cox proportional hazards model, lower plasma n-6 PUFA level (HR 1.62, 95% CI 1.01-2.65), higher serum creatinine (HR 1.83, 95% CI 1.02-3.59), and higher plasma BNP levels (HR 1.60, 95% CI 1.02-2.57) were independent determinants for adverse events, among variables including age, blood pressure, hemoglobin, plasma n-3 PUFA, serum albumin levels. Conclusions: Lower plasma n-6 PUFA level was an independent determinant for adverse events in association with right HF sign and malnutrition, suggesting plasma n-6 PUFA could be a potential surrogate marker for clinical outcome in AHF patients.