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Chen Z, Zha L, Hu B, Xu B, Zuo L, Yang J, Chu Z, Ma L, Hu F. Use of the Serum Level of Cholinesterase as a Prognostic Marker of Nonfatal Clinical Outcomes in Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Can Respir J 2024; 2024:6038771. [PMID: 38505803 PMCID: PMC10950411 DOI: 10.1155/2024/6038771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/27/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) contributes to a poor prognosis. Reliable biomarkers to predict adverse outcomes during hospitalization are important. Aim To investigate the relationship between the serum cholinesterase (ChE) level and adverse clinical outcomes, including hypoxemia severity, hypercapnia, duration of hospital stay (DoHS), and noninvasive ventilation (NIV) requirement, in patients with AECOPD. Methods Patients hospitalized with AECOPD in the Wuhu Hospital of Traditional Chinese Medicine between January 2017 and December 2021 were included. Results A total of 429 patients were enrolled. The serum ChE level was significantly lower in patients with hypercapnia, who required NIV during hospitalization and who had a DoHS of >10 days, with an oxygenation index < 300. The ChE level was correlated negatively with the C-reactive protein level and neutrophil-to-lymphocyte ratio and correlated positively with the serum albumin level. Multivariate logistic regression analysis indicated that a serum ChE level of ≤4116 U/L (OR = 2.857, 95% CI = 1.46-5.58, p = 0.002) was associated significantly with NIV requirement. Conclusions The serum ChE level was correlated significantly with complicating severe hypoxemia, hypercapnia, prolonged DoHS, and the need for NIV in patients hospitalized with AECOPD. The serum ChE level is a clinically important risk-stratification biomarker in patients hospitalized with AECOPD.
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Affiliation(s)
- Zhixiang Chen
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Lei Zha
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu City, Anhui Province, China
| | - Bin Hu
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Bin Xu
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Lin Zuo
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Jun Yang
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Zhuhua Chu
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Lingling Ma
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
| | - Fangfang Hu
- Department of Respiratory and Critical Care Medicine, Wuhu Hospital of Traditional Chinese Medicine, 430 Jiuhua South Road, Wuhu, Anhui Province, China
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Yamashita M, Kamiya K, Hamazaki N, Nozaki K, Uchida S, Maekawa E, Yamaoka-Tojo M, Ako J. Predictive value of cholinesterase in patients with heart failure: A new blood biochemical marker of undernutrition. Nutr Metab Cardiovasc Dis 2023; 33:1914-1922. [PMID: 37500349 DOI: 10.1016/j.numecd.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND AIMS This study was conducted to verify whether serum cholinesterase (ChE) is useful in predicting prognosis and discriminating undernutrition status compared to existing low-nutrition indices of blood chemical tests in patients with heart failure (HF). METHODS AND RESULTS A total of 1617 patients (1204 older patients) with HF who evaluated ChE during hospitalization were recruited for this study. The primary outcome was all-cause death, and multivariate survival analysis was performed. We drew a receiver operating characteristic curve for all-cause death, some undernutrition status, such as low body mass index, thin mid-upper arm circumference, low grip strength, and slow gait speed. The area under the curve was used to compare the predictive ability of ChE with some existing nutritional parameters, such as blood biochemical tests, controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI). After adjusting for 29 variables, higher ChE significantly decreased the risk of all-cause death (per 10 increase, hazard ratio: 0.975, 95% confidence interval: 0.952-0.998), and this trend was maintained for older patients (per 10 increase, hazard ratio: 0.972, 95% confidence interval: 0.947-0.997). ChE was moderately correlated with CONUT and GNRI, but the predictive ability for all-cause death was higher for ChE relative to both scores. ChE tended to have an almost consistently high predictive ability compared with other blood biochemical tests. CONCLUSIONS ChE was associated with all-cause death and an almost consistently higher predictive ability for all-cause death and undernutrition status in comparison to existing blood chemical tests and nutritional scores.
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Affiliation(s)
- Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Division of Research, ARCE Inc., Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Hefter H, Arslan M, Kruschel TS, Novak M, Rosenthal D, Meuth SG, Albrecht P, Hartmann CJ, Samadzadeh S. Pseudocholinesterase as a Biomarker for Untreated Wilson's Disease. Biomolecules 2022; 12:biom12121791. [PMID: 36551217 PMCID: PMC9775970 DOI: 10.3390/biom12121791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to demonstrate that pseudocholinesterase (CHE) serum level is a useful diagnostic biomarker for untreated Wilson's disease (WD). Between 2013 and 2019, about 75 patients were referred to the outpatient department of the University of Düsseldorf with suspected Wilson's disease. In 31 patients with suspected Wilson's disease (WD-SUS-group), WD was excluded by means of investigations other than analysis of blood and urine. A total of 27 parameters of blood and urine in these 31 patients were compared to those of 20 de novo patients with manifest WD (WD-DEF-group), which parameter showed the highest significance level of difference between the WD-DEF-group and the WD-SUS-group. Thereafter, receiver operating characteristics (ROC-curves) were analyzed to evaluate which parameter showed the largest area under the curve (AUC) to detect WD. Finally, a logistic regression analysis was performed to analyze which combination of parameters allowed the best classification of the 51 patients either into the WD-DEF-group or into the WD-SUS-group. CHE showed the highest significance level for a difference between the WD-DEF- and WD-SUS-group, had the highest AUC, and, in combination with ceruloplasmin, allowed 100% correct classification. Without CHE, no other combination of parameters reached this level of correct classification. After the initiation of treatment, which regularly results in an improvement in CHE, the high diagnostic accuracy of this biomarker was lost. Cholinesterase turns out to be an excellent biomarker for differentiation between untreated de novo patients with manifest WD and heterozygotic gene carriers.
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Affiliation(s)
- Harald Hefter
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
- Correspondence: ; Tel.: +49-211-811-7025
| | - Max Arslan
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
- Departments of Anesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Theodor S. Kruschel
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Max Novak
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Dietmar Rosenthal
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Sven G. Meuth
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Philipp Albrecht
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Christian J. Hartmann
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Sara Samadzadeh
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
- Experimental and Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
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Arslan M, Novak M, Rosenthal D, Hartmann CJ, Albrecht P, Samadzadeh S, Hefter H. Cholinesterase Deficiency Syndrome-A Pitfall in the Use of Butyrylcholinesterase as a Biomarker for Wilson's Disease. Biomolecules 2022; 12:biom12101398. [PMID: 36291607 PMCID: PMC9599139 DOI: 10.3390/biom12101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
A family is described as having two recessively inherited metabolic diseases and three differently affected children. During the explantation of a drain tube grommet under general anesthesia, a prolonged resuscitation and wake-up period occurred in the key case when he was 8 years old. This led to a family screening for butyrylcholinesterase deficiency, which was confirmed not only in the key case but also in his 5-year-old sister; it was not confirmed in his 10-year-old brother. However, the key case not only had reduced serum levels of BCHE, but also elevated liver enzyme levels, which are atypical for BCHE deficiency. After the exclusion of viral and autoimmune hepatitis, Wilson’s disease (WD) was eventually diagnosed and also confirmed in his elder brother, but not in his sister. This family is presented to highlight an extremely rare WD-patient in whom a low serum level of BCHE did not occur because of WD but because of BCHE deficiency.
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Affiliation(s)
- Max Arslan
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
- Departments of Anesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Max Novak
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Dietmar Rosenthal
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Christian J. Hartmann
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Philipp Albrecht
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Sara Samadzadeh
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Harald Hefter
- Departments of Neurology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
- Correspondence: ; Tel.: +49-211-811-7025; Fax: +49-211-810-4903
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Uemura Y, Shibata R, Miyagaki Y, Takemoto K, Ishikawa S, Murohara T, Watarai M. A Comparative Study of Three Nutritional Risk/Screening Indices for Predicting Cardiac Events and Physical Functioning Among Patients with Acute Heart Failure. Int Heart J 2022; 63:541-549. [PMID: 35650154 DOI: 10.1536/ihj.21-809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Undernutrition is very common among patients with heart failure (HF). This study evaluated the prognostic values of three nutritional risk/screening indices among patients with acute HF. We retrospectively calculated scores for 465 patients with acute HF using the Controlling Nutritional Status (CONUT) tool, the Geriatric Nutritional Risk Index (GNRI), and the Mini-Nutritional Assessment Short Form (MNA-SF). The outcomes of interest were the 1-year rate of cardiac events (cardiac-related death or HF-related readmission) and the Barthel index as an index of physical function during hospitalization. The CONUT, GNRI, and MNA-SF scores were significantly correlated, although the proportions of a normal nutritional state varied (CONUT: 18.3%, GNRI: 32.9%, and MNA-SF: 43.9%). Kaplan-Meier estimates revealed that cardiac events were more common among patients with undernutrition based on the CONUT score, and multivariable regression analysis revealed that only the CONUT score independently predicted poor outcomes. Furthermore, changes in the Barthel index during hospitalization were significantly correlated with the CONUT score but not with the GNRI and MNA-SF scores. In receiver operating characteristic analyses, the CONUT score had the most powerful predictive values on both the postdischarge incidence of cardiac events and the decline of physical function during hospitalization compared with the GNRI and the MNA-SF. These results indicate that the CONUT score might provide useful information for predicting poor outcomes in patients with acute HF.
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Affiliation(s)
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine
| | | | | | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Reddy Parvathareddy KK, Balla RV, Nagula P, Ravi S, Maale S, Rayapu M. Prognostic significance of serum cholinesterase in acute myocardial infarction. JOURNAL OF CLINICAL AND PREVENTIVE CARDIOLOGY 2022. [DOI: 10.4103/jcpc.jcpc_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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7
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Kinchen JM, Mohney RP, Pappan KL. Long-Chain Acylcholines Link Butyrylcholinesterase to Regulation of Non-neuronal Cholinergic Signaling. J Proteome Res 2021; 21:599-611. [PMID: 34758617 DOI: 10.1021/acs.jproteome.1c00538] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acylcholines are comprised of an acyl chain esterified to a choline moiety; acetylcholine is the best-characterized member of this class, functioning as a neurotransmitter in the central and peripheral nervous systems as well as an inhibitor of cytokine production by macrophages and other innate immune cells. Acylcholines are metabolized by a class of cholinesterases, including acetylcholinesterase (a specific regulator of acetylcholine levels) and butyrylcholinesterase (BChE, an enigmatic enzyme whose function has not been resolved by genetic knockout models). BChE provides reserve capacity to hydrolyze acetylcholine, but its importance is arguable given acetylcholinesterase is the most catalytically efficient enzyme characterized to date. While known to be substrates of BChE in vitro, endogenous production of long-chain acylcholines is a recent discovery enabled by untargeted metabolomics. Compared to acetylcholine, long-chain acylcholines show greater stability in circulation with homeostatic levels-dictated by synthesis and clearance-suggested to impact cholinergic receptor sensitivity of acetylcholine with varying levels of antagonism. Acylcholines then provide a link between BChE and non-neuronal acetylcholine signaling, filling a gap in understanding around how imbalances between acylcholines and BChE could modulate inflammatory disease, such as the "cytokine storm" identified in severe COVID-19. Areas for further research, development, and clinical testing are outlined.
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Affiliation(s)
- Jason M Kinchen
- Owlstone Medical Inc., 600 Park Office Drive, Suite 140, Research Triangle Park, North Carolina 27709, United States
| | - Robert P Mohney
- Owlstone Medical Inc., 600 Park Office Drive, Suite 140, Research Triangle Park, North Carolina 27709, United States
| | - Kirk L Pappan
- Owlstone Medical Inc., 600 Park Office Drive, Suite 140, Research Triangle Park, North Carolina 27709, United States
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Shiba M, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Seko Y, Yamamoto E, Yoshikawa Y, Kitai T, Yamashita Y, Iguchi M, Nagao K, Kawase Y, Morinaga T, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Serum cholinesterase as a prognostic biomarker for acute heart failure. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:335-342. [PMID: 33580775 DOI: 10.1093/ehjacc/zuaa043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022]
Abstract
AIMS The association between serum cholinesterase and prognosis in acute heart failure (AHF) remains to be elucidated. We investigated the serum cholinesterase level at discharge from hospitalization for AHF and its association with clinical outcomes in patients with AHF. METHODS AND RESULTS Among 4056 patients enrolled in the Kyoto Congestive Heart Failure multicentre registry, we analysed 2228 patients with available serum cholinesterase data. The study population was classified into three groups according to serum cholinesterase level at discharge: low tertile (<180 U/L, N = 733), middle tertile (≥180 U/L and <240 U/L, N = 746), and high tertile (≥240 U/L, N = 749). Patients in the low tertile had higher tricuspid pressure gradient, greater inferior vena cava diameter, and higher brain natriuretic peptide (BNP) levels than those in the high tertile. The cumulative 1-year incidence of the primary outcome measure (a composite endpoint of all-cause death and hospitalization for HF) was higher in the low and middle tertiles than in the high tertile [46.5% (low tertile) and 31.4% (middle tertile) vs. 22.1% (high tertile), P < 0.0001]. After adjustment for 26 variables, the excess risk of the low tertile relative to the high tertile for the primary outcome measure remained significant (hazard ratio 1.37, 95% confidence interval 1.10-1.70, P = 0.006). Restricted cubic spline models below the median of cholinesterase demonstrated incrementally higher hazards at low cholinesterase levels. CONCLUSIONS Low serum cholinesterase levels are associated with congestive findings on echocardiography, higher BNP, and higher risks for a composite of all-cause death and HF hospitalization in patients with AHF.
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Affiliation(s)
- Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga General Hospital, Moriyama, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Osawa Y, Abe Y, Takayama M, Oguma Y, Arai Y. Physical activity and all-cause mortality and mediators of the association in the very old. Exp Gerontol 2021; 150:111374. [PMID: 33905878 DOI: 10.1016/j.exger.2021.111374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Physical activity (PA) confers protection to individuals from the risk of death. However, in the very old, the dose-response relationship between PA and all-cause mortality and the possible biological mediators of this association are less known. We investigated whether PA predicts 6-year all-cause mortality and what biomarkers mediate the association. DESIGN Prospective cohort data from the Tokyo Oldest Old Survey on Total Health study. SETTING Community-dwelling population. PARTICIPANTS A total of 441 women and men aged over 85 years. MEASUREMENTS Questionnaire-based PA was assessed at baseline and 3-year and 6-year follow-up visits. Survival status was confirmed up to the 6-year follow-up visit (153 deaths, 34.7%). Data of plasma albumin, cholinesterase, NT-proBNP, interleukin-6, cystatin C, and HbA1c levels were collected. For mediation analysis for survival analysis, we used the baseline PA and biomarkers with Weibull distribution accelerated failure time model and linear regression model adjusted for age, sex, body mass index, smoking, education level, and Mini-Mental State Examination. RESULTS A curvilinear relationship was observed in the association between baseline PA and all-cause mortality. Compared to the inactive (0 METs*h/week), light amount of PA was associated with a lower risk of mortality. Compared to the highest tertile of PA (11.2 METs*h/week), higher PA did not reduce the risk of death. Circulation levels of albumin and cholinesterase mediated the association between baseline PA and all-cause mortality (proportion mediated, 54%, both; p < 0.05). CONCLUSIONS Compared to completely inactive, light PA reduces the risk of all-cause mortality in the very old population. Mediation analysis suggests that protein synthesis in the liver may mediate the association between PA and all-cause mortality. Further studies are needed to understand the underlying association between PA, nutrition, and death.
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Affiliation(s)
- Yusuke Osawa
- Graduate School of Health Management, Keio University, Kanagawa, Japan; Sports Medicine Research Center, Keio University, Kanagawa, Japan; Translational Gerontology Branch, National Institute on Aging, MD, United States.
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Michiyo Takayama
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Oguma
- Graduate School of Health Management, Keio University, Kanagawa, Japan; Sports Medicine Research Center, Keio University, Kanagawa, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan.
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Mito T, Takemoto M, Antoku Y, Tanaka A, Matsuo A, Hida S, Yoshitake K, Kosuga KI, Miura SI. Influence of Serum Cholinesterase Levels on Patients Suspected of Having Stable Coronary Artery Disease. Intern Med 2021; 60:1145-1150. [PMID: 33191322 PMCID: PMC8112985 DOI: 10.2169/internalmedicine.5719-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective The serum cholinesterase (ChE) level has been used for the evaluation of the nutritional status in daily practice. It has been reported that the serum ChE level is significantly more elevated in patients with three-vessel coronary disease than in normal subjects. Thus, the aim of this study was to assess the influence of serum ChE levels in patients suspected of having stable coronary artery disease (CAD). Methods The relationship between myocardial ischemia and the serum ChE levels was evaluated in 559 consecutive patients suspected of having stable CAD without a history of cardiovascular disease admitted to our hospitals to undergo coronary angiography. Results This study revealed that, in patients suspected of having stable CAD, 1) the frequency of myocardial ischemia was significantly increased in accordance with the serum ChE levels (p<0.001); 2) higher ChE levels were associated with a higher body mass index (p<0.001) and the co-existence of dyslipidemia (p<0.001), including higher values of low-density lipoprotein-cholesterol (p<0.001) and triglycerides (p<0.001) and serum albumin (p<0.001), as well as a younger age (p<0.001); 3) the specificity and sensitivity of myocardial ischemia were 0.599 and 0.658 at the ChE level of 286 IU/L, respectively; and 4) an increased serum ChE (OR=1.66, p<0.001) was an independent risk factor for myocardial ischemia, in patients suspected of having stable CAD. Conclusion The serum ChE level may be an important diagnostic biomarker in patients suspected of having stable CAD.
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Affiliation(s)
- Takahiro Mito
- Cardiology, Hakujyuji Hospital, Japan
- Munakata Suikokai General Hospital, Japan
| | - Masao Takemoto
- Munakata Suikokai General Hospital, Japan
- Cardiovascular Center, Steel Memorial Yawata Hospital, Japan
| | - Yoshibumi Antoku
- Munakata Suikokai General Hospital, Japan
- Cardiovascular Center, Steel Memorial Yawata Hospital, Japan
| | | | | | | | | | | | - Shin-Ichiro Miura
- Department of Cardiovascular Medicine, Fukuoka University Hospital, Japan
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Kato T. Cholinesterase: Conflicting Aspects of Two Cardiovascular Diseases. Intern Med 2021; 60:1143-1144. [PMID: 33191332 PMCID: PMC8112984 DOI: 10.2169/internalmedicine.6405-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan
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12
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Ohashi N, Sakao Y, Sato T, Ishigaki S, Isobe S, Fujikura T, Kato A, Yasuda H. Characteristics of adrenal insufficiency in hemodialysis patients. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Adrenal insufficiency causes abnormal subjective symptoms such as general fatigue, signs such as hypotension, and abnormalities such as hypoglycemia and leads to poor prognosis. However, all these are also observed in hemodialysis (HD) patients without adrenal insufficiency. The morphology of the adrenal glands in HD patients with adrenal insufficiency is unclear. Therefore, this study was performed to clarify the characteristics of adrenal insufficiency in HD patients.
Methods
Seventeen HD patients who had abnormal subjective symptoms and test results indicating adrenal insufficiency and whose serum cortisol levels were less than 18 μg/dL were recruited.
Results
Seven HD patients were diagnosed with adrenal insufficiency. No significant differences were found about abnormal subjective symptoms and images between patients with and without adrenal insufficiency. The levels of serum cortisol and serum cholinesterase were significantly lower in patients with adrenal insufficiency than in those without adrenal insufficiency. A plasma cortisol level of 8.45 μg/dL showed the highest sensitivity and specificity in the receiver operating characteristic curve. The serum cortisol levels were significantly and negatively associated with the plasma ferritin levels in patients with adrenal insufficiency. Multiple linear regression analyses revealed that the serum cortisol levels showed a significant negative association with the plasma ferritin levels after adjustments.
Conclusions
It is difficult to infer adrenal insufficiency in HD patients by subjective symptoms and images of the adrenal glands. Adrenal insufficiency correlates with nutritional and inflammatory status, and the levels of serum cholinesterase and plasma ferritin might reflect their corresponding status.
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Sugawara Y, Yoshihisa A, Ishibashi S, Matsuda M, Yamadera Y, Ohara H, Ichijo Y, Watanabe K, Hotsuki Y, Anzai F, Sato Y, Kimishima Y, Yokokawa T, Misaka T, Yamada S, Sato T, Kaneshiro T, Oikawa M, Kobayashi A, Takeishi Y. Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure. CJC Open 2021; 3:778-786. [PMID: 34169257 PMCID: PMC8209365 DOI: 10.1016/j.cjco.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background It has been reported that the pattern of hepatic vein (HV) waveforms determined by abdominal ultrasonography is useful for the diagnosis of hepatic fibrosis in patients with chronic liver disease. We aim to clarify the clinical implications of HV waveform patterns in patients with heart failure (HF). Methods We measured HV waveforms in 350 HF patients, who were then classified into 3 categories based on their waveforms: those with a continuous pattern (C group); those whose V wave ran under the baseline (U group), and those with a reversed V wave (R group). We performed right-heart catheterization, and examined the rate of postdischarge cardiac events, such as cardiac death and rehospitalization due to worsening HF. Results The number of patients in each of the 3 HV waveform groups was as follows: C group, n = 158; U group, n = 152, and R group, n = 40. The levels of B-type natriuretic peptide (R vs C and U; 245.8 vs 111.7 and 216.6 pg/mL; P < 0.01) and mean right atrial pressure (10.5 vs 6.7 and 7.2 mm Hg; P < 0.01) were highest in the R group compared with the other groups. The Kaplan-Meier analysis found that cardiac event–free rates were lowest in the R group among all groups (log-rank P < 0.001). In the multivariable Cox proportional hazard analysis, the R group was found to be an independent predictor of cardiac events (hazard ratio, 4.90; 95% confidence interval, 2.23-10.74; P < 0.01). Conclusion Among HF patients, those with reversed V waves had higher right atrial pressure and were at higher risk of adverse prognosis.
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Affiliation(s)
- Yukiko Sugawara
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Shinji Ishibashi
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mitsuko Matsuda
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yukio Yamadera
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Himika Ohara
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Koichiro Watanabe
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Yu Hotsuki
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Fumiya Anzai
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Yu Sato
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Yusuke Kimishima
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine Fukushima Medical University Hospital, Fukushima, Japan
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14
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Zou S, Dong R, Wang J, Liang F, Zhu T, Zhao S, Zhang Y, Wang T, Zou P, Li N, Wang Y, Chen M, Zhou C, Zhang T, Luo L. Use of data-independent acquisition mass spectrometry for comparative proteomics analyses of sera from pregnant women with intrahepatic cholestasis of pregnancy. J Proteomics 2021; 236:104124. [PMID: 33545297 DOI: 10.1016/j.jprot.2021.104124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
We used data-independent acquisition (DIA) proteomics technology followed by ELISAs and automated biochemical analyses to identify and validate protein expression levels in Intrahepatic Cholestasis of Pregnancy (ICP) and healthy pregnant controls. We employed bioinformatics to identify metabolic processes associated with differentially expressed proteins.The expression levels of two proteins (S100-A9 and the L-lactate dehydrogenase A chain) were significantly higher in ICP patients than in controls; the areas under the receiver operating characteristic (ROC) curves (AUCs) were 0.774 and 0.828, respectively. The expression levels of two other proteins (apolipoprotein A-I and cholinesterase) were significantly lower in patients, with values of 0.900 and 0.842, respectively. Multiple logistic regression showed that a combination of the levels of the four proteins optimized the AUC (0.962), thus more reliably diagnosing ICP. The levels of all four proteins were positively associated with that of total bile acids. Bioinformatics analyses indicated that the four proteins principally affected neutrophil activation involved in the immune response, cell adhesion, lipoprotein metabolism, and the PPAR signaling pathway. SIGNIFICANCE: This preliminary work improves our understanding of changes in serum levels of protein in pregnant women with ICP. The four proteins may serve as novel noninvasive biomarkers for ICP.
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Affiliation(s)
- Shaohan Zou
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310000, China
| | - Ruirui Dong
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Jing Wang
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Fengbing Liang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310000, China
| | - Tingting Zhu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou 310000, China
| | - Shaojie Zhao
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Yan Zhang
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Tiejun Wang
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Ping Zou
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Na Li
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Yao Wang
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Minjian Chen
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Conghua Zhou
- School of Computer Science and Telecommunication Engineering, Jiangsu University, Zhenjiang 212013, China
| | - Ting Zhang
- The Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi 214002, China.
| | - Liang Luo
- The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi 214002, China.
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15
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Takahara M, Iida O, Soga Y, Azuma N, Nanto S. Clinical Impact of Measures for Frailty Severity in Poor-Risk Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia. J Atheroscler Thromb 2021; 29:221-228. [PMID: 33518553 PMCID: PMC8803558 DOI: 10.5551/jat.61481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim:
This study aimed to demonstrate the clinical impact of various frailty-related aspects in poor-risk patients undergoing revascularization for chronic limb-threatening ischemia (CLTI).
Methods:
We analyzed a clinical database of a prospective multicenter observational study. A total of 562 CLTI patients who required assistance for their daily lives and were candidates for revascularization were included. We examined various measures of frailty severity, including activities of daily living (ADL)/mobility, physical performance, nutritional status, cognitive function, and cardiac function at baseline (before revascularization). Data on inflammatory markers at baseline and ADL/mobility before CLTI onset were also collected.
Results:
The patients were aged 77±10 years, 65% were non-ambulatory, and 38% were categorized as mild dementia or severer. The correlation coefficients between the frailty measures ranged from 0.00 to 0.91. The random forest analysis for one-year mortality risk showed that these frailty-related measures, as well as age and inflammatory markers, had a relatively high variable importance compared with comorbidities and limb severity.
Conclusion:
The correlations between measures of frailty severity were not always strong but rather widely varied in CLTI patients who required assistance for their daily lives and were candidates for revascularization. Measures of frailty severity, as well as age and inflammatory markers, had a relatively large predictive impact on one-year mortality risk compared with comorbidities and limb severity in the population.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital
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Admission serum cholinesterase concentration for prediction of in-hospital mortality in very elderly patients with acute ischemic stroke: a retrospective study. Aging Clin Exp Res 2020; 32:2667-2675. [PMID: 32067216 DOI: 10.1007/s40520-020-01498-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/28/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cholinesterase as a sensitive biomarker for prognosis in a variety of conditions but it is rare in stroke studies. The very elderly (≥ 80 years of age) represent the most susceptible group of ischemic stroke. We aimed to determine whether admission serum cholinesterase concentration had any effect on clinical outcome in very elderly patients (individuals aged ≥ 80 years) with acute ischemic stroke. METHODS A retrospective record review was conducted in two tertiary university hospitals. Elderly patients aged ≥ 80 years admitted with a diagnosis of acute ischemic stroke from January 1, 2014 to November 30, 2019, who had a cholinesterase concentration drawn, were included. The patients were grouped based on the inflection points of the locally weighted regression and smoothing scatterplot (LOESS) curve between cholinesterase levels and in-hospital mortality (study outcome) with lower concentration as reference group. RESULTS A total of 612 patients were admitted with a diagnosis of acute ischemic stroke, and 569 met the inclusion criteria. A threshold effect was identified using regression smoothing scatterplot (LOESS), with one cutoff point of 4.0 KU/L. There was a significant difference in-hospital mortality was observed (P < 0.001). After adjusted demographic and clinical features, the OR of cholinesterase for mortality was 0.43 (95% CI 0.34-0.54, P < 0.001), suggesting that lower admission cholinesterase level was an independent risk factors for all-cause mortality among patients with AIS. CONCLUSIONS We have demonstrated a significant association between admission cholinesterase concentration and in-hospital mortality in very elderly patients with AIS.
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Kałużna-Oleksy M, Krysztofiak H, Migaj J, Wleklik M, Dudek M, Uchmanowicz I, Lesiak M, Straburzyńska-Migaj E. Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up. Nutrients 2020; 12:nu12082330. [PMID: 32759722 PMCID: PMC7468814 DOI: 10.3390/nu12082330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Heart Failure (HF) is a cardiovascular disease with continually increasing morbidity and high mortality. The purpose of this study was to analyze nutritional status in patients diagnosed with HF with reduced ejection fraction (HFrEF) and evaluate the impact of malnutrition on their prognosis. The Polish version of MNA form (Mini Nutritional Assessment) was used to assess the patients’ nutritional status. The New York Heart Association (NYHA) class, exacerbation of HF, chosen echocardiographic and biochemical parameters, e.g., natriuretic peptides or serum albumin, were also analyzed. Among the 120 consecutive patients, 47 (39%) had a normal nutritional status, 62 (52%) were at risk of malnutrition and 11 (9%) were malnourished. The patients with malnutrition more frequently presented with HF exacerbation in comparison to those with normal nutritional status (82% vs. 30% respectively, p = 0.004). There were no significant differences between the investigated groups as to natriuretic peptides; however, both the malnourished patients and those at risk of malnutrition tend to show higher B-type natriuretic peptide (BNP) and NT-proBNP concentrations. During the average 344 days of follow-up 19 patients died and 25 were hospitalized due to decompensated HF. Malnutrition or being at risk of malnutrition seems to be associated with both worse outcomes and clinical status in HFrEF patients.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Correspondence: ; Tel.: +48-535-600-625
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Marta Wleklik
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
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18
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Usefulness of the plasma branched-chain amino acid/aromatic amino acid ratio for predicting future cardiac events in patients with heart failure. J Cardiol 2020; 75:689-696. [DOI: 10.1016/j.jjcc.2019.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
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Seo M, Yamada T, Tamaki S, Hikoso S, Yasumura Y, Higuchi Y, Nakagawa Y, Uematsu M, Abe H, Fuji H, Mano T, Nakatani D, Fukunami M, Sakata Y. Prognostic Significance of Serum Cholinesterase Level in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction: Insights From the PURSUIT-HFpEF Registry. J Am Heart Assoc 2019; 9:e014100. [PMID: 31847660 PMCID: PMC6988145 DOI: 10.1161/jaha.119.014100] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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). 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; 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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Affiliation(s)
- Masahiro Seo
- Division of Cardiology Osaka General Medical Center Osaka Japan
| | - Takahisa Yamada
- Division of Cardiology Osaka General Medical Center Osaka Japan
| | - Shunsuke Tamaki
- Division of Cardiology Osaka General Medical Center Osaka Japan
| | - Shungo Hikoso
- Division of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Yoshio Yasumura
- Department of Cardiology Amagasaki Chuo Hospital Amagasaki Japan
| | | | - Yusuke Nakagawa
- Division of Cardiology Kawanishi City Hospital Kawanishi Japan
| | - Masaaki Uematsu
- Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan
| | - Haruhiko Abe
- Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan
| | - Hisakazu Fuji
- Cardiovascular Division Kobe Ekisaikai Hospital Kobe Japan
| | - Toshiaki Mano
- Division of Cardiology Kansai Rosai Hospital Amagasaki Japan
| | - Daisaku Nakatani
- Division of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
| | | | - Yasushi Sakata
- Division of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan
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20
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Seo M, Yamada T, Tamaki S, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Abe M, Nakamura J, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Kimura T, Ueda K, Sakamoto D, Sakata Y, Fukunami M. Prognostic significance of serum cholinesterase in patients with acute decompensated heart failure: a prospective comparative study with other nutritional indices. Am J Clin Nutr 2019; 110:330-339. [PMID: 31161211 DOI: 10.1093/ajcn/nqz103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/01/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Nutritional status is associated with poor outcomes in patients with heart failure. Serum cholinesterase (CHE) concentration, a marker of malnutrition, was reported to be a prognostic factor in patients with chronic heart failure. The geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score, and the prognostic nutritional index (PNI) are established objective nutritional indices. OBJECTIVE The aim of this study was to clarify the prognostic significance of CHE concentration and to compare it with other well-established objective nutritional indices in patients with acute decompensated heart failure (ADHF). METHODS We prospectively enrolled 371 consecutive patients admitted for ADHF with survival discharge. Laboratory data including CHE and the objective nutritional indices were obtained at discharge. The primary endpoint of this study was all-cause mortality. RESULTS During a mean ± SD follow-up period of 2.5 ± 1.4 y, 112 patients died. CHE concentration was significantly associated with all-cause mortality independently of GNRI, CONUT score, or PNI, after adjustment for major confounders including other nutritional indices, such as age, sex, systolic blood pressure, BMI, left ventricular ejection fraction, history of hypertension, diabetes mellitus, dyslipidemia, prior heart failure hospitalization, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, β-blocker use, statin use, hemoglobin, sodium, blood urea nitrogen, albumin, C-reactive protein, and brain natriuretic peptide concentrations via multivariable Cox analysis. Kaplan-Meier analysis revealed that the risk of all-cause mortality significantly increased in accordance with CHE stratum [lowest tertile: 53%, adjusted HR: 6.92; 95% CI: 3.87, 12.36, compared with middle tertile: 28%, adjusted HR: 2.72; 95% CI: 1.45, 5.11, compared with highest tertile: 11%, adjusted HR: 1.0 (reference), P < 0.0001]. CHE showed the best area under the curve value (0.745) for the prediction of all-cause mortality compared with the other objective nutritional indices. Net reclassification improvement afforded by adding CHE to the fully adjusted multivariable model was statistically significant for all-cause mortality (0.330; 95% CI: 0.112, 0.549, P = 0.0030). CONCLUSION CHE is a simple, strong prognostic marker for the prediction of all-cause mortality in patients with ADHF.
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Affiliation(s)
- Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Furukawa
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yusuke Iwasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Makoto Abe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kyoko Yamamoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kiyomi Kayama
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Kazuya Tanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takanari Kimura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kunpei Ueda
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daisuke Sakamoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yasushi Sakata
- Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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21
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Matsuo M, Yamagami T. Low serum cholinesterase predicts complication risk after orthopedic surgery in elderly patients: an observational pilot study. JA Clin Rep 2019; 5:39. [PMID: 32025927 PMCID: PMC6967189 DOI: 10.1186/s40981-019-0259-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serum cholinesterase (ChE) in elderly adults is associated with geriatric conditions such as sarcopenia and malnutrition. The aim of this study is to examine the impact of preoperative serum ChE on the development of complications after noncardiac surgery in elderly patients without liver cirrhosis. METHODS We retrospectively identified all patients aged ≥ 65 years who underwent orthopedic surgery over a 1.5-year period in our hospital. The main outcome was postoperative complications, defined as a deviation from the normal postoperative course within 30 days postoperatively. RESULTS A total of 313 patients (median age 79 years) were included. The incidence of all-cause postoperative complications was 15.7% (49/313 patients). Receiver operating characteristic curve analysis showed that serum ChE was a univariable factor that predicted all-cause complications with moderate accuracy (area under the curve = 0.694, 95% confidence interval (CI) 0.604-0.783), with an optimal serum ChE cutoff level of 200 units/L. After multivariate analyses adjusted by baseline characteristics, low serum ChE remained a significant risk factor for postoperative complications (odds ratio = 2.99, 95% CI 1.41-6.33, P = 0.004). CONCLUSIONS Low serum ChE (< 200 unit/L) is a significant risk factor for postoperative complications after orthopedic surgery in patients aged ≥ 65 years.
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Affiliation(s)
- Mitsuhiro Matsuo
- Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan.
| | - Tohru Yamagami
- Department of Orthopedic Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
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22
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Schweitzer N, Kirstein MM, Kratzel AM, Mederacke YS, Fischer M, Manns MP, Vogel A. Second-line chemotherapy in biliary tract cancer: Outcome and prognostic factors. Liver Int 2019; 39:914-923. [PMID: 30716200 DOI: 10.1111/liv.14063] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The prognosis of biliary tract cancer (BTC) is poor. Standard treatment for advanced BTC is a chemotherapy (CT) with gemcitabine and cisplatin. Phase III evidence for a second-line (2L) CT is lacking. We aimed to investigate the feasibility of a 2L CT, to estimate the outcome and to identify prognostic markers. METHODS Patients of our institution with advanced BTC between 2000 and 2015 receiving CT were included. Data were analysed in univariate and multivariate analysis. RESULTS Three-hundred and fifteen and 144 patients (45.7%) received first-line (1L) and 2L CT respectively. The OS of patients receiving 2L CT was 16.67 and 9.9 months from the beginning of 1L and 2L CT respectively. The overall response rate and the disease control rate after 3 months were 9.7% and 33.6% respectively. Adverse events of grade 3 or more were observed in 26.1%. One patient died of gemcitabine-related haemolytic uraemic syndrome. Age of more than 70 years was not associated with a poor outcome. In multivariate analysis, CEA levels of >3 µg/L (P = 0.004, hazard ratio [HR] 1.89, 95% CI 1.22, 2.91), cholinesterase (CHE) levels of <5 kU/L (P = 0.001, HR 2.11, 95% CI 1.34, 3.31) and leukocytosis (P = 0.001, HR 2.90, 95% CI 1.51, 5.56) were associated with poor survival. CONCLUSIONS Despite a relevant toxicity, our data suggest that 2L CT may be feasible in fit BTC patients. CEA elevation, leukocytosis and low CHE levels are unfavourable prognostic markers. Results from prospective randomized trials are urgently awaited.
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Affiliation(s)
- Nora Schweitzer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Internal Medicine I, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Anna-Maria Kratzel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Internal Medicine and Gastroenterology, Sankt Bernward Hospital Hildesheim, Hildesheim, Germany
| | - Young-Seon Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Mareike Fischer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Cardiology, Angiology and Intensive Care, Klinikum Hildesheim, Hildesheim, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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23
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Takegawa R, Kabata D, Shimizu K, Hisano S, Ogura H, Shintani A, Shimazu T. Serum albumin as a risk factor for death in patients with prolonged sepsis: An observational study. J Crit Care 2019; 51:139-144. [PMID: 30825787 DOI: 10.1016/j.jcrc.2019.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/22/2019] [Accepted: 02/02/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to evaluate an association between nutritional biomarkers and prognosis in septic patients. METHODS We retrospectively searched the association between nutritional biomarkers including serum albumin (Alb), total protein (TP), total cholesterol (T-chol), and cholinesterase (ChE), and prognosis for septic patients treated in the ICU for >7 days. We used time-dependent Cox proportional hazard regression analysis to resolve the difference of the statistical weight of each day's data for all 14 consecutive days among individual sepsis patients. The covariates were based on the minimum moving values determined from 1 day, 3 days, 7 days, and 14 days of serial data. The values of these covariates and ICU survival were considered as outcomes. RESULTS We included 136 septic patients. The decreases in the values of Alb, TP, T-chol, and ChE were significantly associated with the risk of death in the septic patients (p < .05). Especially, the daily changes of Alb were significantly associated with mortality during the ICU stay (p < .05). CONCLUSIONS We found that the changes in serial data of the nutritional markers of Alb, TP, T-chol, and ChE reflected the higher risk of death in patients with prolonged sepsis.
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Affiliation(s)
- Ryosuke Takegawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka city, Osaka 545-0051, Japan.
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - Saya Hisano
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka city, Osaka 545-0051, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka city, Osaka 545-0051, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Osaka 565-0871, Japan.
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24
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Saito Y, Kato M, Nagashima K, Monno K, Aizawa Y, Okumura Y, Matsumoto N, Moriyama M, Hirayama A. Prognostic Relevance of Liver Stiffness Assessed by Transient Elastography in Patients With Acute Decompensated Heart Failure. Circ J 2018; 82:1822-1829. [PMID: 29669970 DOI: 10.1253/circj.cj-17-1344] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is often accompanied by liver congestion through increased right atrial pressure (RAP). Liver stiffness (LS) assessed non-invasively using transient elastography is related to increased RAP and liver congestion in patients with general HF. We investigated the relationship of LS with clinical and echocardiographic variables and outcomes in patients with ADHF.Methods and Results:The subjects were 105 patients with ADHF admitted to hospital between October 2016 and June 2017. Patients were divided into 2 groups based on median LS at admission (low LS <8.8 kPa [n=52] vs. high LS ≥8.8 kPa [n=53]). Death from cardiovascular disease and readmission for HF were primary endpoints. Total bilirubin and γ-glutamyl transpeptidase levels, MELD-XI score, diameters of the inferior vena cava and right ventricle, and severity of tricuspid regurgitation were greater in the high LS group (all P<0.05). During a median (interquartile range) follow-up period of 153 (83-231) days, cardiac events occurred in 29 patients (54%) in the high LS group and in 13 (25%) in the low LS group (P=0.001). After adjusting for variables that influence organ congestion, a high LS ≥8.8 kPa was still significantly associated with cardiac events (all P<0.05). CONCLUSIONS Increased LS measured by transient elastography reflects RAP elevation, hepatic congestion, and hepatic dysfunction. LS upon admission may be a useful prognostic marker in patients with ADHF.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Mahoto Kato
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koyuru Monno
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yoshihiro Aizawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Naoki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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25
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Kitagaki K, Nakanishi M, Ono R, Yamamoto K, Suzuki Y, Fukui N, Yanagi H, Konishi H, Yanase M, Fukushima N. Cholinesterase levels predict exercise capacity in cardiac recipients early after transplantation. Clin Transplant 2018; 32. [PMID: 29194762 DOI: 10.1111/ctr.13170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Although cardiac rehabilitation is recommended for patients early after heart transplantation (HTx), adequate exercise effect cannot always be obtained, partly because in patients with chronic heart failure, exercise capacity is reduced due to malnutrition while waiting for HTx. This study aimed to investigate the relationships between exercise capacity and clinical variables, including nutritional indicators, early after HTx. PATIENTS AND METHODS Forty-three HTx recipients were studied. The mean age at HTx was 38 ± 14 years, and 86% were male. We assessed the relationships between peak oxygen uptake (VO2 ) and clinical variables, including plasma B-type natriuretic peptide (BNP), isometric knee extensor muscle strength (KEMS), and nutritional indicators within 1 week of their respective discharges. RESULTS Peak VO2 correlated positively with isometric KEMS (r = .63, P < .0001) and negatively with BNP level (r = -.37, P = .015). Of the nutritional indicators, only cholinesterase levels had a significant relationship with peak VO2 (r = .34, P = .028), whereas the Geriatric Nutritional Risk Index and the Controlling Nutritional Status scores did not. In multiple linear regression analysis, cholinesterase levels and isometric KEMS were independent predictors of peak VO2 . CONCLUSION Cholinesterase levels predicted exercise capacity early after HTx.
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Affiliation(s)
- Kazufumi Kitagaki
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan.,Graduate School of Health Science, Kobe University, Kobe, Japan
| | - Michio Nakanishi
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Rei Ono
- Graduate School of Health Science, Kobe University, Kobe, Japan
| | - Kazuya Yamamoto
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Suzuki
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Noriyuki Fukui
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hidetoshi Yanagi
- Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Harumi Konishi
- Department of Nursing, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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26
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Increased serum Wisteria floribunda agglutinin positive Mac-2 binding protein (Mac-2 binding protein glycosylation isomer) in chronic heart failure: a pilot study. Heart Vessels 2017; 33:385-392. [PMID: 29098408 DOI: 10.1007/s00380-017-1071-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/20/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Serum Wisteria floribunda agglutinin positive Mac-2 binding protein (WFA+-M2BP) or Mac-2 Binding Protein Glycosylation Isomer (M2BPGi) is a novel biomarker currently applied for evaluating hepatic fibrosis. The aim of this study was to evaluate the utility of serum WFA+-M2BP level as a biomarker in chronic heart failure (HF) patients with abnormal liver function. METHODS AND RESULTS Fifty chronic HF patients who underwent measurement of serum WFA+-M2BP were evaluated. The median value of serum WFA+-M2BP was 0.88 (interquartile range 0.48-1.29) cut-off index, and positive WFA+-M2BP (≥ 1.00 cut-off index) was observed in 22 (44%). Elevated WFA + -M2BP was associated with longer HF history, older age, female sex, valvular heart disease, decreased estimated glomerular filtration rate (eGFR), albumin, and cholinesterase. Stepwise multiple regression analysis showed that HF history, eGFR, and albumin were independent determinants of serum WFA+-M2BP values. Repeated measurements of serum WFA+-M2BP suggested association between the decrease of WFA+-M2BP and improvement of New York Heart Association (NYHA) functional class. CONCLUSIONS Elevation of serum WFA+-M2BP showed a high prevalence in chronic HF patients with abnormal liver function with relation to HF history, decreased hepatic protein synthesis, and renal dysfunction. Our results suggest that serum WFA+-M2BP may be a novel biomarker of chronic HF.
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27
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Suzuki H, Nodera M, Kamioka M, Kaneshiro T, Kamiyama Y, Takeishi Y. Intracardiac impedance after cardiac resynchronization therapy is a novel predictor for worsening of heart failure. Heart Vessels 2017; 32:926-931. [DOI: 10.1007/s00380-017-0953-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/20/2017] [Indexed: 01/07/2023]
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28
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Cheng BN, Jin YL, Chen BQ, Zhu LY, Xu ZC, Shen T. Serum cholinesterase: a potential assistant biomarker for hand, foot, and mouth disease caused by enterovirus 71 infection. Infect Dis Poverty 2016; 5:27. [PMID: 27025584 PMCID: PMC4812613 DOI: 10.1186/s40249-016-0124-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/24/2016] [Indexed: 01/21/2023] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) caused by enterovirus 71 (EV71) is a potentially life-threatening infectious disease that commonly occurs in children. Diagnosis of HFMD caused by EV71 largely depends on clinical manifestations and rare serological biomarkers used to identify children suffering from HFMD. Serum cholinesterase (SChE) activity has frequently been reported as a potential biomarker for solid central nervous system tumors, chronic heart failure, and liver cirrhosis. However, its potential value in the diagnosis of neurotropic virus infections, such as HFMD caused by EV71, remains to be determined. Findings In our study, 220 children hospitalized with HFMD caused by EV71, 34 inpatients infected with coxsackievirus A16 (CVA16), and 43 undefined enterovirus-infected HFMD inpatients were recruited at the Anhui Provincial Children’s Hospital between January 2011 and December 2012. SChE activity was measured. The non-parametric Mann–Whitney U test showed that SChE activity in children diagnosed with HFMD caused by EV71 was significantly higher than in healthy controls (p < 0.001), as well as in children with upper respiratory tract infections (p = 0.011), bronchopneumonia (p < 0.001), septicemia (p < 0.001), amygdalitis (p < 0.001), and appendicitis (p < 0.001). In addition, higher SChE activity was observed in male inpatients with HFMD caused by EV71 (47.7 % positivity) compared to female inpatients (26.1 % positivity) (chi-square test, p = 0.002). In our study, no significant differences in SChE levels were observed among different ages (up to 120 months) (r = -0.112, p > 0.05). An important finding was that SChE activity declined in the recovery phase of HFMD caused by EV71 compared to the acute phase (p < 0.001). Conclusions Elevated SChE activity was observed in patients with severe HFMD caused by EV71. Therefore, SChE might be a potential assistant biomarker for the diagnosis of HFMD caused by EV71 in children. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0124-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bang-Ning Cheng
- Clinical Laboratory Center, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Yu-Lian Jin
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Bi-Quan Chen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Li-Yan Zhu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Zi-Cheng Xu
- Clinical Laboratory Center, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Tao Shen
- Clinical Laboratory Center, Anhui Provincial Children's Hospital, Hefei, 230051, China. .,Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing, 100191, China.
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Okada A, Sugano Y, Nagai T, Takashio S, Honda S, Asaumi Y, Aiba T, Noguchi T, Kusano KF, Ogawa H, Yasuda S, Anzai T. Prognostic Value of Prothrombin Time International Normalized Ratio in Acute Decompensated Heart Failure – A Combined Marker of Hepatic Insufficiency and Hemostatic Abnormality –. Circ J 2016; 80:913-23. [DOI: 10.1253/circj.cj-15-1326] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Seiji Takashio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo F. Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Cornelis J, Beckers P, Vanroy C, Volckaerts T, Vrints C, Vissers D. An overview of the applied definitions and diagnostic methods to assess exercise oscillatory ventilation--a systematic review. Int J Cardiol 2015; 190:161-9. [PMID: 25918072 DOI: 10.1016/j.ijcard.2015.04.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/14/2015] [Indexed: 12/17/2022]
Abstract
The variable "exercise oscillatory ventilation" (EOV), assessed during cardiopulmonary exercise test (CPET), recently became a fundamental prognostic parameter in patients with heart failure. In literature, various definitions are suggested, but an uniformly accepted description to identify EOV still lacks. We performed a systematic review of the literature in order to determine the different definitions and diagnostic techniques to assess EOV. A systematic search strategy was established and executed in seven databases (PubMed, Google Scholar, Cochrane Clinical Trials, Science Direct, Pedro, Web Of Science library and Medline (Ovid)) resulting in 605 citations after de-duplication. Full-text articles (n=124) were assessed for eligibility, resulting in 75 citations. The review accounted 17,440 patients of whom 4,638 subjects presented EOV. Seven studies described EOV in a non-heart failure population accounting 168 EOV subjects. The definitions could be categorized in nine subdivisions of which four (n=43) referred to an original description. The other subdivisions were combinations of the original definitions (n=11), quantifications (n=4), computational (n=3), vaguely described (n=8) or not defined (n=6). Symptom limited maximal exercise tests were conducted to assess EOV, however the modes, protocols, software and data sampling were divers. Heterogeneity in the numerous definitions to identify EOV and the vaguely described assessment methods are hindering the evolution to a standardized uniformly accepted definition and technique to identify this abnormal breathing pattern. Unity in definition and international adopted assessment is warranted to strengthen its validity as a prognostic marker and could promote communication. It may facilitate clinical trials on pathophysiology and origin of EOV.
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Affiliation(s)
- Justien Cornelis
- University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.
| | - Paul Beckers
- University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp (Faculty of Medicine and Health Sciences), Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Christel Vanroy
- University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; University of Leuven (Faculty of Kinesiology and Rehabilitation Sciences), Tervuursevest 101, B-3001 Heverlee, Belgium; University of Antwerp (Faculty of Medicine and Health Sciences), Translational Neurosciences, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Tess Volckaerts
- University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium
| | - Christiaan Vrints
- Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp (Faculty of Medicine and Health Sciences), Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Dirk Vissers
- University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium
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Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation. Heart Vessels 2015; 31:722-33. [PMID: 25735775 DOI: 10.1007/s00380-015-0654-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
There is a paucity of data about mid-term outcome of patients with advanced heart failure (HF) treated with left ventricular assist device (LVAD) in Europe, where donor shortage and their aging limit the availability and the probability of success of heart transplantation (HTx). The aim of this study is to compare Italian single-centre mid-term outcome in prospective patients treated with LVAD vs. HTx. We evaluated 213 consecutive patients with advanced HF who underwent continuous-flow LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1 year (3/2013). We compared outcome in patients who received a LVAD (n = 49) with those who underwent HTx (n = 164) and in matched groups of 39 LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse risk profile in comparison with HTx patients. Kaplan-Meier survival curves estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx patients, a difference that was non-statistically significant [hazard ratio (HR) 1.46; 95 % confidence interval (CI) 0.74-2.86; p = 0.27 for LVAD vs. HTx]. After group matching 1-year survival was similar between LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44-2.98; p = 0.78). Concordant data was observed at 2-year follow-up. Patients treated with LVAD as bridge-to-transplant indication (n = 22) showed a non significant better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1- and 2-year follow-up, respectively. Despite worse preoperative conditions, survival is not significantly lower after LVAD than after HTx at 2-year follow-up. Given the scarce number of donors for HTx, LVAD therapy represents a valid option, potentially affecting the current allocation strategy of heart donors also in Europe.
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