HbA1c and FIB-4 as Serologic Markers for the Risk of Progression of Stage A Heart Failure

Background The classic association of glycemic control as represented by glycosylated hemoglobin (Glyco% or HbA1c) with progression of micro and macro vascular clinical complications is well documented. However, use of the advanced glycation end product (AGE) axis as a marker for early diastolic hemodynamic changes leading to clinical heart failure has been suggested but is less well characterized. This study explored the association between elevated Glyco% and Fibrosis 4 (FIB-4, a 4-component marker for liver fibrosis) values and worsening measures of diastolic cardiac function in order to assess their utility as early serologic markers in cardiovascular disease prevention. Methods and Results A Retrospective cohort analysis was conducted in 102 patients presenting to the Parkview Medical Center health system who had received a full resting echo characterized by normal systolic ejection fraction and clinical risk factors associated with stage A heart failure in conjunction with Glyco% and FIB-4 scores all within a 3-month time window. Using regression analysis, measures of diastolic cardiac function were assessed in conjunction with rising Glyco% levels characterized as <6.5 and > 6.5 and FIB-4 scores after controlling for the presence of hypertension, coronary artery disease and valvular heart disease. Glyco% levels > 6.5 were significantly associated with a higher E/e’ ratio and closely associated with an elevated left atrial volume index both indicative of elevated left atrial pressure as a sensitive marker for diastolic cardiac dysfunction. FIB-4 scores did not appear to be clinically associated with progression of diastolic dysfunction. Conclusions Glyco%, long known to be a marker for metabolic glycemic control can also act as an early marker for identifying patients at increased risk for the progression of stage A heart failure. FIB-4 scores cannot. Registration https://clinicaltrials.gov/ct2/show/NCT04450576?term=duffee&draw=2&rank=3