Key result
Low serum cholinesterase levels were significantly associated with a greater risk of cardiovascular death and readmission for worsening heart failure compared to middle or high levels (P=0.0025).
Why the study?
Malnutrition is an important comorbidity in HFpEF, and this study aimed to clarify the prognostic role and incremental value of serum cholinesterase in patients with HFpEF and acute decompensated heart failure.
Does serum cholinesterase level predict adverse outcomes in patients with acute decompensated heart failure with preserved ejection fraction?
Observational (n=274)
Yes
Does serum cholinesterase level predict adverse outcomes in patients with acute decompensated heart failure with preserved ejection fraction?
p-value: p=0.0025
Serum cholinesterase is a useful prognostic marker that improves risk prediction when added to the MAGGIC risk score in patients with acute decompensated HFpEF.
May support cholinesterase as prognostic marker in acute decompensated HFpEF; hypothesis-generating and requires prospective validation.
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 ( P =0.0025). C holinesterase 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; P =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.
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Seo et al. (2019) conducted an observational in acute decompensated heart failure with preserved ejection fraction (n=274). Low serum cholinesterase level vs. Middle or high serum cholinesterase levels was evaluated on composite of cardiovascular death and readmission for worsening heart failure (p=0.0025). Low serum cholinesterase levels were significantly associated with a greater risk of cardiovascular death and readmission for worsening heart failure compared to middle or high levels (P=0.0025).
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