Abstract 11011: Comparison of Prognostic Value of Liver Dysfunction Scores and Serum Cholinesterase Level in Acute Decompensated Heart Failure Patients with Preserved Left Ventricular Ejection Fraction: Insights from Pursuit-hfpef Registry

Abstract

Background: Cardiohepatic interactions have been a focus of attention in heart failure. Liver dysfunction scores such as Fibrosis-4 (FIB-4) index, albumin-bilirubin (ALBI) and nonalcoholic fatty liver disease (NAFLD) scores have been shown to be useful for predicting poor outcome in patients (pts) with heart failure. On the other hand, malnutrition is one of the most important comorbidities in patients with heart failure with preserved ejection fraction (HFpEF), and serum cholinesterase level (CHE) was reported to be associated with adverse prognosis. We sought to compare the prognostic value of liver dysfunction scores and CHE in HFpEF pts admitted for acute decompensated heart failure (ADHF). Methods and Results: Data were extracted from a prospective multicenter observational study (PURSUIT-HFpEF) in which collaborating hospitals in Osaka recorded clinical, echocardiographic, and outcome data of HFpEF pts with ADHF. We analyzed 737 pts who survived to discharge. CHE, FIB-4 index, ALBI and NAFLD scores were obtained just before the discharge. During a follow-up period of 1.8±1.0 years, 157 pts had all-cause death. At multivariate Cox analysis, CHE (p<0.0001) was independently and significantly associated with all-cause death after adjustment with important baseline clinical and study characteristics, although FIB-4 index, ALBI and NAFLD scores showed the association with all-cause death at univariate analysis. Receiver-operating characteristic curve analysis showed that CHE had the largest area under the curve for the prediction of all-cause death. Kaplan-Meier analysis revealed that the pts with lower CHE (<208 IU/L=median value) had a significantly higher risk of all-cause death than those with higher CHE (31% vs 11%, p<0.0001, adjusted hazard ratio 3.29 [95% CI 2.31 to 4.69]). Conclusion: CHE would be a more useful and simple prognostic marker for the prediction of total mortality than liver dysfunction scores in HFpEF pts with ADHF.