Division of Cardiology Osaka General Medical Center Osaka Japan.
Division of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan.
J Am Heart Assoc. 2020 Jan 7;9(1):e014100. doi: 10.1161/JAHA.119.014100. Epub 2019 Dec 18.
Background Malnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction. We recently reported the prognostic significance of serum cholinesterase level and superior predictive power of cholinesterase level to other objective nutritional indices such as the controlling nutritional status score, prognostic nutritional index, and geriatric nutritional risk index in patients with acute decompensated heart failure. The aim of this study was to clarify the prognostic role of cholinesterase in patients with heart failure with preserved ejection fraction/acute decompensated heart failure and investigate incremental cholinesterase value. Methods and Results We prospectively studied 274 consecutive patients from the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure With Preserved Ejection Fraction) study. During a follow-up period of 1.2±0.6 years, 56 patients reached the composite end points (cardiovascular death and readmission for worsening heart failure). In the multivariable Cox analysis, cholinesterase level was significantly associated with the composite end points after adjustment for major confounders. A Kaplan-Meier analysis revealed that patients with low cholinesterase levels (stratified by tertile) had significantly greater risk of reaching the composite end points than those with middle or high cholinesterase levels (=0.0025). Cholinesterase level showed the best C-statistics (0.703) for prediction of the composite end points among the objective nutritional indices. C-statistics of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for prediction of the composite end points were improved when cholinesterase level was added (C-statistics, from 0.601 to 0.705; =0.0408). Conclusions Cholinesterase was a useful prognostic marker for prediction of adverse outcome in patients with heart failure with preserved ejection fraction/acute decompensated heart failure.
在射血分数保留的心力衰竭（HFpEF）患者中，营养不良是最重要的合并症之一。我们最近报告了血清胆碱酯酶水平的预后意义，以及与其他客观营养指标（如控制营养状况评分、预后营养指数和老年营养风险指数）相比，胆碱酯酶水平对急性失代偿性心力衰竭患者的预测能力更强。本研究旨在阐明胆碱酯酶在射血分数保留的心力衰竭/急性失代偿性心力衰竭患者中的预后作用，并探讨胆碱酯酶的增量价值。
我们前瞻性地研究了来自 PURSUIT-HFpEF（射血分数保留的心力衰竭前瞻性多中心观察性研究）研究的 274 例连续患者。在 1.2±0.6 年的随访期间，56 例患者达到了复合终点（心血管死亡和心力衰竭恶化再入院）。多变量 Cox 分析显示，调整主要混杂因素后，胆碱酯酶水平与复合终点显著相关。Kaplan-Meier 分析显示，胆碱酯酶水平较低（按三分位分层）的患者达到复合终点的风险显著高于胆碱酯酶水平中等或较高的患者（=0.0025）。在客观营养指标中，胆碱酯酶水平对复合终点的预测具有最佳的 C 统计量（0.703）。当加入胆碱酯酶水平时，Meta-Analysis Global Group in Chronic Heart Failure（MAGGIC）风险评分对复合终点的预测的 C 统计量得到改善（从 0.601 提高至 0.705；=0.0408）。
胆碱酯酶是预测射血分数保留的心力衰竭/急性失代偿性心力衰竭患者不良结局的有用预后标志物。
