Doi Takahiro, Nakata Tomoaki, Tsuzuki Taro, Mita Tomohiro, Nagahara Daigo, Yuda Satoshi, Hashimoto Akiyoshi
Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan.
Department of Cardiology, Hakodate Goryokaku Hospital, Hakodate, Japan.
Front Cardiovasc Med. 2023 Sep 29;10:1131282. doi: 10.3389/fcvm.2023.1131282. eCollection 2023.
Cardiac mortality in patients with heart failure (HF) is likely to be aggravated by malnutrition, assessed by serum cholinesterase (ChE) level, as well as by kidney dysfunction or impairment of cardiac sympathetic denervation. Their prognostic interactions, however, have not been determined.
A total of 991 systolic HF patients were enrolled in our HF database following clinical evaluation including evaluation of the nutrition state and assessment of standardized heart-to-mediastinum ratio (sHMR) of iodine-123-labeled meta-iodobenzylguanidine activity. Patients were followed up for an average of 43 months with the primary endpoint of fatal cardiac events (CEs).
The CE patient group had a lower level of ChE, lower estimated glomerular filtration rate (eGFR) and lower late sHMR than those in the non-CE patient group. A five-parameter model with the addition of serum ChE selected in the multivariate logistic analysis (model 2) significantly increased the AUC predicting risk of cardiac events compared with a four-parameter model without serum ChE (model 1), and net reclassification analysis also suggested that the model with the addition of serum cholinesterase significantly improved cardiac event prediction. Moreover, in overall multivariate Cox hazard analysis, serum ChE, eGFR and late sHMR were identified to be significant prognostic determinants. HF patients with two or all of the prognostic variables of serum ChE < 230 U/L, eGFR < 48.8 ml/min/1.73 m and late sHMR < 1.90 had significantly and incrementally increased CE rates compared to those in HF patients with none or only one of the prognostic variables.
Decreases in cholinesterase level and kidney function further increase cardiac mortality risk in HF patients with impairment of cardiac sympathetic innervation.
心力衰竭（HF）患者的心脏死亡率可能会因营养不良（通过血清胆碱酯酶（ChE）水平评估）、肾功能不全或心脏交感神经去神经支配受损而加重。然而，它们之间的预后相互作用尚未确定。
共有991例收缩性HF患者纳入我们的HF数据库，进行临床评估，包括营养状态评估和碘-123标记的间碘苄胍活性的标准化心纵隔比（sHMR）评估。患者平均随访43个月，主要终点为致命性心脏事件（CEs）。
与非CE患者组相比，CE患者组的ChE水平较低、估计肾小球滤过率（eGFR）较低且晚期sHMR较低。在多变量逻辑分析中选择的加入血清ChE的五参数模型（模型2）与未加入血清ChE的四参数模型（模型1）相比，显著提高了预测心脏事件风险的AUC，净重新分类分析也表明加入血清胆碱酯酶的模型显著改善了心脏事件预测。此外，在总体多变量Cox风险分析中，血清ChE、eGFR和晚期sHMR被确定为显著的预后决定因素。与没有或只有一个预后变量的HF患者相比，血清ChE<230 U/L、eGFR<48.8 ml/min/1.73 m²和晚期sHMR<1.90这两个或所有预后变量的HF患者的CE发生率显著且逐步增加。
胆碱酯酶水平和肾功能的降低进一步增加了心脏交感神经支配受损的HF患者的心脏死亡风险。
