Free fatty acids: independent predictors of long-term adverse cardiovascular outcomes in heart failure patients

Fig. 1. Flowchart of the study subject inclusion process

Fig. 2. RCS curves modeling the relationships between plasma FFA levels and the three long-term adverse outcomes, including CV death & HHP (a), CV death (b), and ACM (c). A) Analysis of the entire heart failure patient population; B) analysis of the HFrEF cohort, which included HFmrEF individuals; C) analysis of the HFpEF cohort. The point where the dashed line intersects the X-axis represents the plasma FFA level corresponding to the inflection point of the RCS curve. The adjusted covariates in the Cox multiple regression models included age, sex, BMI, smoking status, alcohol consumption, major comorbidities (type 2 diabetes, hypertension, atrial fibrillation, and coronary artery disease), serum creatinine, NT-proBNP, hs-CRP, and the prescription of ACE inhibitors/ARBs/ARNIs, β-blockers, MRAs, and SGLT2 inhibitors at discharge

Fig. 3. Kaplan-Meier curves depicting the incidence of cardiovascular death and heart failure hospitalization (A), cardiovascular death (B), and all-cause mortality (C) in patients with normal versus elevated FFA levels (defined as > 0.45 mmol/L in female patients and > 0.60 mmol/L in male patients). (Note: Ref: the reference group; adj. HR: adjusted hazard ratio)

Fig. 4. Forest plots displaying the results of stratified analyses and interaction tests. In the whole cohort, the overall HRs for the three adverse outcomes were derived from a Cox proportional hazards regression model, representing the risk associated with an increase of one standard deviation (SD) in the continuous variable. Pint: P for interaction. BMI: body mass index; CAD: coronary artery disease; HBP: hypertension; HF: heart failure; HFpEF: heart failure with preserved ejection fraction. T2DM: Type 2 diabetes mellitus; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; LDL-C: low-density lipoprotein cholesterol

Fig. 5. Receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC) values for different models predicting cardiovascular death and heart failure hospitalization (A), cardiovascular death (B), and all-cause mortality (C). (Note: CV death & HHP: cardiovascular death and heart failure hospitalization; CV death: cardiovascular death; ACM: all-cause mortality.)