Total Serum Protein as an Independent Predictor of Heart Failure with Preserved Ejection Fraction in Obese Pediatric Population

Objectives: We aimed to clarify the prognostic role of Total Serum Protein (TSP) in obese children with HFpEF and its using as an effective and noninvasive approach for screening of target population. Methods: In total, 587 patients who enrolled in our unique program aimed for children’s obesity treatment were referred. Among these patients, we identified and retrospectively studied 64 patients who met our criteria and compared them with 24 lean healthy subjects. Baseline examination, routine blood testing and transthoracic echocardiography were obtained. Results: We revealed that obese patients had higher TSP levels compared to them with normal weight. They also had worse echocardiographic results including a lower Left Ventricular Ejection Fraction (LVEF) and E/A ratio. Positive correlations between TSP and Pulmonary Artery Systolic Pressure (PASP), Left Atrial Volume Index (LAVI), and Interventricular Septal Systolic/Diastolic Dimension (IVSs, IVSd) and negative TSP correlations with LVEF and E/A ratio were found, too. Compared to the commonly used Albumin-to-Globulin Ratio (AGR), the TSP was a better metabolic predictor. There were more significant correlations in obese subgroup with HFpEF than to those without HFpEF. Conclusions: We first indicated that higher TSP levels are positively associated with obesity and HFpEF in children and could be used as a more easily available biomarker which provides a more-accurate HFpEF risk evaluation of obese pediatric population group than other objective indices, possibly allowing early implementation of appropriate intervention in daily practice and leads to better outcomes and early prevention in patients with higher HF risk.