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 http://www.cardiologyres.org

Original Article

Volume 10, Number 3, June 2019, pages 181-187

Clinical Significance of Skin Autofluorescence in Elderly Patients With Long-Standing Persistent Atrial Fibrillation

Figure 2. Relationship between skin autofluorescence and components of the CHADS₂ score. Comparisons are between those with and without the following factors: CHF (3.1 ± 0.5 AU vs. 2.7 ± 0.5 AU, respectively, P < 0.001), age ≥ 75 years (2.9 ± 0.5 AU vs. 2.5 ± 0.4 AU, respectively, P < 0.001), diabetes mellitus (3.0 ± 0.5 AU vs. 2.7 ± 0.5 AU, respectively, P = 0.019), and stroke/TIA (3.0 ± 0.5 AU vs. 2.7 ± 0.5 AU, respectively, P < 0.001). *P = 0.598, **P = 0.019, ***P < 0.001. AF: autofluorescence; AU: arbitrary units; CHF: congestive heart failure; TIA: transient ischemic attack.

Figure 3. Receiver-operating characteristic curve analysis for the detection of high CHADS₂ scores or elevated hs-cTnT levels based on skin autofluorescence. The maximum Youden’s index indicated that skin autofluorescence values > 2.6 AU and > 2.7 AU are the optimal cutoff points to identify high CHADS₂ scores (≥ 2) or elevated hs-cTnT levels (> 0.014 ng/mL), respectively. (a) CHADS₂ score. (b) hs-cTnT levels. AF: autofluorescence; AU: arbitrary unit; hs-cTnT: high-sensitivity cardiac troponin T; AUC: area under the curve.

**Table 1.** Patient Characteristics
Continuous values are mean ± SD. AU: arbitrary units; LDL: low-density lipoprotein; HDL: high-density lipoprotein; 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; WBPT: whole blood passage time; RAS: renin-angiotensin system; DOAC: direct oral anticoagulant.
n (male/female)	112 (46/66)
Age (years)	81 ± 9
Skin autofluorescence (AU)	2.8 ± 0.5
CHADS₂ score	3 ± 2
Body mass index (kg/m²)	22.6 ± 3.5
Current smoker, n (%)	14 (13)
Hypertension, n (%)	75 (67)
Systolic blood pressure (mm Hg)	131 ± 11
Diastolic blood pressure (mm Hg)	76 ± 9
Dyslipidemia, n (%)	76 (68)
Total cholesterol (mg/dL)	218 ± 41
LDL cholesterol (mg/dL)	137 ± 37
Triglyceride (mg/dL)	127 ± 66
HDL cholesterol (mg/dL)	55 ± 15
Diabetes mellitus, n (%)	30 (27)
Fasting blood glucose (mg/dL)	104 ± 32
Hemoglobin A1c (%)	5.9 ± 0.6
IVSTd (mm)	9.7 ± 2.2
LVDd (mm)	51.5 ± 5.9
LVEF (%)	64.4 ± 12.2
LAD (mm)	46.9 ± 6.8
eGFR (mL/min/1.73m² )	51.8 ±19.1
Log-BNP (pg/mL)	2.3 ± 0.4
Log-hs-cTnT (ng/mL)	-1.8 ± 0.4
d-ROMs test (U. CARR)	325 ± 82
WBPT (s)	59.5 ± 18.3
Medication
RAS inhibitor, n (%)	61 (55)
β blocker, n (%)	23 (21)
Diuretics, n (%)	31 (28)
Statin, n (%)	35 (31)
Warfarin/DOAC, n (%)	33 (29)/79 (71)

Table 1. Patient Characteristics

Continuous values are mean ± SD. AU: arbitrary units; LDL: low-density lipoprotein; HDL: high-density lipoprotein; 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; WBPT: whole blood passage time; RAS: renin-angiotensin system; DOAC: direct oral anticoagulant.

n (male/female)

112 (46/66)

Age (years)

81 ± 9

Skin autofluorescence (AU)

2.8 ± 0.5

CHADS₂ score

3 ± 2

Body mass index (kg/m²)

22.6 ± 3.5

Current smoker, n (%)

14 (13)

Hypertension, n (%)

75 (67)

Systolic blood pressure (mm Hg)

131 ± 11

Diastolic blood pressure (mm Hg)

76 ± 9

Dyslipidemia, n (%)

76 (68)

Total cholesterol (mg/dL)

218 ± 41

LDL cholesterol (mg/dL)

137 ± 37

Triglyceride (mg/dL)

127 ± 66

HDL cholesterol (mg/dL)

55 ± 15

Diabetes mellitus, n (%)

30 (27)

Fasting blood glucose (mg/dL)

104 ± 32

Hemoglobin A1c (%)

5.9 ± 0.6

IVSTd (mm)

9.7 ± 2.2

LVDd (mm)

51.5 ± 5.9

LVEF (%)

64.4 ± 12.2

LAD (mm)

46.9 ± 6.8

eGFR (mL/min/1.73m² )

51.8 ±19.1

Log-BNP (pg/mL)

2.3 ± 0.4

Log-hs-cTnT (ng/mL)

-1.8 ± 0.4

d-ROMs test (U. CARR)

325 ± 82

WBPT (s)

59.5 ± 18.3

Medication

RAS inhibitor, n (%)

61 (55)

β blocker, n (%)

23 (21)

Diuretics, n (%)

31 (28)

Statin, n (%)

35 (31)

Warfarin/DOAC, n (%)

33 (29)/79 (71)

**Table 2.** Relationship Between Skin Autofluorescence and Various Clinical Parameters
	r	P value
r expressed correlation coefficient. LDL: low-density lipoprotein; HDL: high-density lipoprotein; 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; WBPT: whole blood passage time; RAS: renin-angiotensin system; DOAC: direct oral anticoagulant.
Sex (female = 0, male = 1)	-0.14	0.139
Body mass index	-0.13	0.183
Current smoker (no = 0, yes = 1)	0.24	0.009
Systolic blood pressure	0.02	0.852
Diastolic blood pressure	-0.03	0.732
Dyslipidemia (no = 0, yes = 1)	0.02	0.852
Total cholesterol	0.02	0.837
LDL cholesterol	0.01	0.924
Triglyceride	0.05	0.582
HDL cholesterol	-0.12	0.190
Fasting blood glucose	0.06	0.566
Hemoglobin A1c	0.24	0.012
IVSTd	0.02	0.861
LVDd	0.08	0.319
LVEF	0.11	0.251
LAD	0.19	0.051
eGFR	-0.37	< 0.001
Log-BNP	0.32	< 0.001
Log-hs-cTnT	0.43	< 0.001
d-ROMs test	0.52	< 0.001
WBPT	0.45	< 0.001
RAS inhibitor (no = 0, yes = 1)	-0.16	0.048
β blocker (no = 0, yes = 1)	0.14	0.137
Diuretics (no = 0, yes = 1)	0.18	0.062
Statin (no = 0, yes = 1)	0.09	0.351
Anticoagulant (warfarin = 0, DOAC = 1)	-0.04	0.965

Table 2. Relationship Between Skin Autofluorescence and Various Clinical Parameters

P value

r expressed correlation coefficient. LDL: low-density lipoprotein; HDL: high-density lipoprotein; 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; WBPT: whole blood passage time; RAS: renin-angiotensin system; DOAC: direct oral anticoagulant.

Sex (female = 0, male = 1)

-0.14

0.139

Body mass index

-0.13

0.183

Current smoker (no = 0, yes = 1)

0.24

0.009

Systolic blood pressure

0.02

0.852

Diastolic blood pressure

-0.03

0.732

Dyslipidemia (no = 0, yes = 1)

0.02

0.852

Total cholesterol

0.02

0.837

LDL cholesterol

0.01

0.924

Triglyceride

0.05

0.582

HDL cholesterol

-0.12

0.190

Fasting blood glucose

0.06

0.566

Hemoglobin A1c

0.24

0.012

IVSTd

0.02

0.861

LVDd

0.08

0.319

LVEF

0.11

0.251

LAD

0.19

0.051

eGFR

-0.37

< 0.001

Log-BNP

0.32

< 0.001

Log-hs-cTnT

0.43

< 0.001

d-ROMs test

0.52

< 0.001

WBPT

0.45

< 0.001

RAS inhibitor (no = 0, yes = 1)

-0.16

0.048

β blocker (no = 0, yes = 1)

0.14

0.137

Diuretics (no = 0, yes = 1)

0.18

0.062

Statin (no = 0, yes = 1)

0.09

0.351

Anticoagulant (warfarin = 0, DOAC = 1)

-0.04

0.965

**Table 3.** Multiple Regression Analysis for Skin Autofluorescence
Explanatory factor	β	P value
R² = 0.47. WBPT: whole blood passage time; d-ROMs: derivatives of reactive oxygen metabolites; hs-cTnT: high sensitivity cardiac troponin T; β: standardized regression coefficient; R²: coefficient of determination.
CHADS₂ score	0.33	< 0.001
WBPT	0.25	0.002
d-ROMs test	0.21	0.019
Log-hs-cTnT	0.19	0.020

Table 3. Multiple Regression Analysis for Skin Autofluorescence

Explanatory factor

P value

R² = 0.47. WBPT: whole blood passage time; d-ROMs: derivatives of reactive oxygen metabolites; hs-cTnT: high sensitivity cardiac troponin T; β: standardized regression coefficient; R²: coefficient of determination.

CHADS₂ score

0.33

< 0.001

WBPT

0.25

0.002

d-ROMs test

0.21

0.019

Log-hs-cTnT

0.19

0.020