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Title: Serum cholinesterase as a prognostic biomarker for acute heart failure
Authors: Shiba, Masayuki
Kato, Takao
Morimoto, Takeshi
Yaku, Hidenori
Inuzuka, Yasutaka
Tamaki, Yodo
Ozasa, Neiko
Seko, Yuta
Yamamoto, Erika
Yoshikawa, Yusuke
Kitai, Takeshi
Yamashita, Yugo  kyouindb  KAKEN_id
Iguchi, Moritake
Nagao, Kazuya
Kawase, Yuichi
Morinaga, Takashi
Toyofuku, Mamoru
Furukawa, Yutaka
Ando, Kenji
Kadota, Kazushige
Sato, Yukihito
Kuwahara, Koichiro
Kimura, Takeshi
Author's alias: 柴, 昌行
加藤, 貴雄
小笹, 寧子
山本, 絵里香
山下, 侑吾
木村, 剛
Keywords: Heart failure
Issue Date: 11-May-2021
Publisher: Oxford University Press (OUP)
Journal title: European Heart Journal. Acute Cardiovascular Care
Volume: 10
Issue: 3
Start page: 335
End page: 342
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.
Rights: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
DOI(Published Version): 10.1093/ehjacc/zuaa043
PubMed ID: 33580775
Appears in Collections:Journal Articles

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