Advanced glycated end products (AGEs) accumulate systemically and cause diabetes complications. However, whether noninvasive measurable AGEs are associated with diabetes status and physical functions remains unclear. One hundred and ten patients with cardiovascular disease (CVD) who underwent outpatient cardiac rehabilitation were included. AGEs scores, using AGEs sensors, were evaluated concomitantly with a physical evaluation, including testing the isometric knee extension strength (IKES) and 6 min walking distance (6MWD). Thirty-three (30%) patients had a history of diabetes mellitus (DM). The AGEs score was not different in the presence of DM history (0.52 ± 0.09 vs. 0.51 ± 0.09, p = 0.768) and was not correlated with blood glucose (r = 0.001, p = 0.995). The AGEs score was positively correlated with hemoglobin A1c (HbA1c, r = 0.288, p = 0.004) and negatively correlated with physical functions (IKES, r = −0.243, p = 0.011; 6MWD, r = −0.298, p = 0.002). The multivariate analysis demonstrated that 6MWD was independently associated with a high AGEs score (>0.52). The AGEs score was associated with HbA1c, IKES, and 6MWD in patients with CVD. The AGEs score might be a useful indicator for evaluating not only glycemic control but also physical functions.

The accumulation of advanced glycation end products (AGEs) is associated with cardiovascular events in patients with cardiovascular disease (CVD). However, the relationship between the AGEs measured by an AGEs sensor noninvasively at the fingertip and prognosis in patients with CVD remains unclear. Therefore, this study aimed to determine the relationship between AGEs score and prognosis among patients with CVD. A total of 191 outpatients with CVD were included. AGEs score were measured using an AGEs sensor and the patients were classified into groups by the median value of AGEs score. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) at 30 months was compared between high- and low-AGEs score groups. In addition, receiver operating characteristic (ROC) curve analysis was used to calculate cutoff value for the AGEs score, which discriminates the occurrence of MACCE. Cox regression analysis was performed to identify the factors associated with the presence of MACCE. MACCE included cardiac death, myocardial infarction, percutaneous coronary intervention, heart failure, and stroke. AGEs score was normally distributed, with a median value of 0.51. No significant intergroup differences were found in laboratory findings, physical functions, or medications. The high-AGEs score group had a significantly higher incidence of MACCE than the low-AGEs score group (27.1 vs. 10.5%, P = 0.007). A high-AGEs score was a risk factor for MACCE (hazard ratio, 2.638; 95% confidence interval, 1.271–5.471; P = 0.009). After the adjustment for confounders other than 6-min walking distance, the AGEs score remained a factor associated with the occurrence of MACCE. The best cutoff AGEs score for the detection of MACCE was 0.51 (area under the curve, 0.642; P = 0.008; sensitivity, 72.2%; specificity, 54.8%). AGEs score measured at the fingertip in patients with CVD is associated with MACCE. AGEs score, which can be measured noninvasively and easily, may be useful as an assessment for the secondary prevention of CVD in patients with CVD.

Cardiac amyloidosis is typically suspected based on various echocardiographic signs termed ‘red flags.’¹ In this case, we present clinical and pathological findings focused on the inferior vena cava (IVC) in a patient with cardiac amyloidosis. A 95-year-old female was admitted at our hospital for shortness of breath. Upon admission, echocardiography revealed unexplained left ventricular thickness (interventricular septum thickness 14 mm, posterior wall thickness 13 mm) and brightness that resembled a granular sparkling sign with preserved ejection fraction (left ventricular ejection fraction 53%, Panel A). Because of her advanced age, the patient denied invasive clinical examinations and subsequently died of heart failure after 5 days. Pathological examination conducted at her family’s request revealed amyloid deposition in the left ventricular wall through direct fast scarlet (DFS) staining (Panel B). Retrospectively, echocardiography detected high-contrast and hypertrophy of the IVC wall (IVC wall thickness 3.0 mm, Panel C) compared with the normal range.² Macroscopic findings also showed venous hypertrophy and sclerosis (Panel D). Light microscopy specifically revealed extracellular deposition of misfolded proteins in the IVC wall (Panel E). DFS staining revealed diffuse amyloid deposition in the IVC wall (Panel F). Although a previous pathological report clarified that amyloid deposition can occur in the whole body including the veins,^3,4 this is the first clinical report focused on cardiac amyloidosis in the IVC. IVC findings on echocardiography, such as those observed in this case, may provide useful additional information in the diagnosis of cardiac amyloidosis.