• HFpEF
• NT-proBNP
• acute heart failure
• biomarker

• Humans
• Male
• Natriuretic Peptide, Brain/blood
• Peptide Fragments/blood
• Female
• Heart Failure/blood
• Heart Failure/physiopathology
• Heart Failure/diagnosis
• Heart Failure/mortality
• Aged
• Registries
• Stroke Volume/physiology
• Prognosis
• Biomarkers/blood
• Prospective Studies
• Aged, 80 and over
• Follow-Up Studies

• Advanced machine learning
• Diagnosis of new clinical indicators
• Heart failure
• Hypertension in adults
• Molecular structure of NRG-1 protein

• Humans
• Heart Failure/diagnosis
• Heart Failure/genetics
• Heart Failure/metabolism
• Machine Learning
• Neuregulin-1/chemistry
• Neuregulin-1/genetics
• Neuregulin-1/metabolism
• Hypertension/diagnosis
• Hypertension/genetics
• Hypertension/metabolism
• Adult
• Biomarkers
• Male
• Female
• Middle Aged
• Computational Biology/methods
• Mutation

• Congestive heart failure
• Net benefit
• Nomogram
• PNI
• Prognostic model

• Humans
• Heart Failure/mortality
• Nomograms
• Female
• Male
• Aged
• Prognosis
• Retrospective Studies
• Follow-Up Studies
• Survival Rate/trends
• Risk Assessment/methods
• Time Factors
• Cause of Death/trends
• Middle Aged
• Risk Factors

• 2021J01388 Fujian Province Natural Science Foundation
• 2020J011072 Fujian Province Natural Science Foundation
• 2021CXA008 Fujian Provincial Health Commission Science and Technology Plan
• Fujian Province Natural Science Foundation

• Clinical Frailty Scale
• Frailty
• Heart failure with preserved ejection fraction
• β-blocker

• Humans
• Male
• Heart Failure/drug therapy
• Heart Failure/physiopathology
• Heart Failure/mortality
• Heart Failure/complications
• Female
• Adrenergic beta-Antagonists/therapeutic use
• Stroke Volume/physiology
• Stroke Volume/drug effects
• Aged, 80 and over
• Aged
• Registries
• Frail Elderly
• Prognosis
• Frailty
• Risk Factors
• Ventricular Function, Left/drug effects
• Ventricular Function, Left/physiology
• Japan/epidemiology
• Cause of Death/trends

• Heart failure
• Malnutrition
• Nutrition assessment
• Nutritional risk
• Prognosis

• Humans
• Aged
• Nutritional Status
• Nutrition Assessment
• Malnutrition/diagnosis
• Prognosis
• Heart Failure

• AECOPD
• biomarker
• mortality
• prediction model
• serum cholinesterase

• Humans
• Prognosis
• Pulmonary Disease, Chronic Obstructive
• Hospital Mortality
• Retrospective Studies
• Disease Progression
• Cholinesterases

• All-cause deaths
• Cholinesterase
• Nutrition
• Physical function

• Humans
• Aged
• Cholinesterases
• Risk Factors
• Nutritional Status
• Heart Failure
• Nutrition Assessment
• Malnutrition/diagnosis
• Biomarkers
• Prognosis
• Retrospective Studies
• Geriatric Assessment/methods

• autonomic breathing test
• invasive mechanical ventilation
• nutrition
• serum cholinesterase
• weaning

• Diastolic dysfunction
• HFpEF
• Indeterminate diastolic function
• Normal diastolic function

• EQ-5D
• HFpEF
• Quality of life

• Wilson’s disease
• biomarker
• cholinesterase
• diagnosis of Wilson’s disease
• heterozygotic gene carriers

• Humans
• Biomarkers/blood
• Biomarkers/urine
• Butyrylcholinesterase/blood
• Butyrylcholinesterase/urine
• Ceruloplasmin/analysis
• Ceruloplasmin/urine
• Hepatolenticular Degeneration/diagnosis
• ROC Curve

• Wilson’s disease
• biomarker
• cholinesterase deficiency
• therapy monitoring

• Male
• Child
• Humans
• Aged
• Child, Preschool
• Hepatolenticular Degeneration/diagnosis
• Hepatolenticular Degeneration/genetics
• Butyrylcholinesterase
• Copper/metabolism
• Biomarkers

Butyrylcholinesterase (BChE) is an important biomarker in serum, and aberrant BChE activity indicates onset and progression of human diseases. The duration of serum storage at −80 °C may introduce variability into and compromise the reproducibility of BChE activity measurements.

We collected serum samples from eight healthy volunteers and determined serum BChE activity in these samples using a sensitive fluorescence assay at various time points during a six-month storage period at −80 °C. Changes in averaged BChE activity over storage time were assessed by repeated measures analysis of variance (ANOVA). Sidak multiple comparisons test was also used to perform post-hoc analysis.

Almost all determined BChE activity values lay within the normal physiological range of BChE activity. However, repeated measures ANOVA using mean BChE activity vs. storage time showed that BChE activity values from two time points were significantly different. Analysis by Sidak multiple comparisons test provided no substantial change of BChE activity during the first 90 days of storage, but BChE activity noticeably decreased after 90 days.

Serum samples stored in −80 °C for up to 90 days can be exploited to accurately determine BChE activity.

•

Butyrylcholinesterase (BChE) activity was measured by a fluorescence turn-on assay.

• Activity
• Butyrylcholinesterase
• Repeated measures ANOVA
• Serum
• Sidak multiple comparisons test
• Temperature

In the past years, only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease (ADHD), most of which were individual case reports or lacked detailed clinical information. Although many studies have reported patients presenting to the emergency department (ED) with recurrent abdominal symptoms for a number of disorders, there are few data involving ADHD. However, owing to a lack of awareness of the disease, misdiagnoses and mistreatments are common. Severe complications such as perforation, bleeding, malabsorption, and even death in ADHD had been reported by many studies.

To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.

We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital. Their basic information, clinical manifestations, and imaging findings were analyzed. Blood indices were compared between the ADHD and irritable bowel syndrome (IBS) groups.

Adult patients with ADHD had a mean age of 48.8 ± 14.3 years, and 77.4% had been treated before admission. The transverse colon was the most common dilated part (73.6%), and constipation (67.9%) was the most common symptom. ADHD patients can present with uncommon symptoms and false-negative imaging findings. Logistic regression analysis indicated that body mass index (BMI) [odds ratio (OR) = 0.786, P = 0.013], cholinesterase (per 1000 units; OR = 0.693, P = 0.008), and blood chlorine (OR = 0.816, P = 0.022) were determined to be independent related factors between the ADHD and IBS groups. The area under the receiver operating characteristics curve of these three indices combined was 0.812 (P < 0.001).

Emergency physicians should be vigilant regarding patients with chronic constipation, abdominal pain, or abdominal distension, and consider the possibility of ADHD despite its rarity. Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD. BMI, cholinesterase, and blood chlorine have good discriminative abilities between ADHD and IBS. The nutritional status of adult patients with ADHD is worthy of further attention. Surgical treatment for adult patients with ADHD is important and inevitable.

• Allied disorders of Hirschsprung’s disease
• Emergency department
• Clinical characteristics
• Misdiagnosis and mistreatment
• Timely diagnosis

• acute pancreatitis
• biomarker
• cholinesterase
• inflammation
• mortality

Although it is known that assessment and management of the nutritional status of patients are important for treatment of patients with heart failure (HF), there are currently no established indicators. Therefore, we investigated the effects of nutritional parameters as well as conventional parameters on the prognosis of HF patients. A total of 1954 consecutive HF patients with left ventricular ejection fraction (LVEF) less than 50% were enrolled in this study. Transthoracic echocardiography was performed and conventional parameters for HF patients and parameters to assess nutritional status were measured in all patients. Patients were followed up with a primary endpoint of lethal cardiac events (CEs) for 30.2 months. During the follow-up period, cardiac events were documented in 619 HF patients. The CEs group had a lower level of cholinesterase (201.5U/L vs 265.2U/L, P <0.0001), lower estimated GFR (35.2 ml/min/1.73m² vs 50.3ml/min/1.73m², P< 0.0001), and lower Geriatric Nutritional Risk Index (GNRI) (91.9 vs 100.0, P< 0.0001) than those in the non-CEs group. Serum cholinesterase, estimated GFR, and GNRI were identified as significant prognostic determinants in multivariate analysis. ROC analyses revealed cut-off values of serum cholinesterase, estimated GFR, and GNRI of 229U/L, 34.2 ml/min/1.73m², and 95.6, respectively, for identifying high-risk HF patients. HF patients with serum cholinesterase< 229U/L, estimated GFR<34.3 ml/min/1.73m², and GNRI< 95.6 had a significantly greater rate of CEs than that in the other patients (P<0.0001). Low serum cholinesterase and low GNRI can predict cardiac mortality risk in systolic HF patients with renal dysfunction.

• Aged
• Cholinesterases
• Heart Failure
• Heart Failure, Systolic/complications
• Humans
• Kidney Diseases
• Nutrition Assessment
• Nutritional Status
• Prognosis
• Stroke Volume
• Ventricular Function, Left

• Cholinesterase
• Colorectal cancer
• Survival

The effectiveness of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin II receptor blockers (ARB) has not been demonstrated in patients with heart failure with preserved ejection fraction (HFpEF). We recently reported significant interaction between the use of ACE‐I and/or ARB (ACE‐I/ARB) and frailty on prognosis in patients with HFpEF. In the present study, we examined the association between ACE‐I/ARB and prognosis in patients with HFpEF stratified by the presence or absence of frailty.

We examined the association between the use of ACE‐I/ARB and prognosis according to the presence [Clinical Frailty Scale (CFS) ≥ 5] or absence (CFS ≤ 4) of frailty in patients with HFpEF in a post hoc analysis of registry data. Primary endpoint was the composite of all‐cause mortality and heart failure admission. Secondary endpoints were all‐cause mortality and heart failure admission. Of 1059 patients, median age was 83 years and 45% were male. Kaplan–Meier analysis showed that the risk of composite endpoint (log‐rank P = 0.001) and all‐cause death (log‐rank P = 0.005) in patients with ACE‐I/ARB was lower in those with CFS ≥ 5, but similar between patients with and without ACE‐I/ARB in patients with CFS ≤ 4 (composite endpoint: log‐rank P = 0.830; all‐cause death: log‐rank P = 0.192). In a multivariable Cox proportional hazards model, use of ACE‐I/ARB was significantly associated with lower risk of the composite endpoint [hazard ratio (HR) = 0.52, 95% confidence interval (CI) = 0.33–0.83, P = 0.005] and heart failure admission (HR = 0.45, 95% CI = 0.25–0.83, P = 0.010) in patients with CFS ≥ 5, but not in patients with CFS ≤ 4 (composite endpoint: HR = 1.41, 95% CI = 0.99–2.02, P = 0.059; heart failure admission: HR = 1.43, 95% CI = 0.94–2.18, P = 0.091). The association between ACE‐I or ARB and prognosis did not significantly differ by CFS (CFS ≤ 4: log‐rank P = 0.562; CFS ≥ 5: log‐rank P = 0.100, for with ACE‐I vs. ARB, respectively). Adjusted HRs for CFS 1–4 were higher than 1.0 but were <1.0 at CFS 5.

In patients with HFpEF, use of ACE‐I/ARB was associated with better prognosis in patients with frailty as assessed with the CFS, but not in those without frailty.

The prognostic value of serum chloride level has been reported primarily in patients with heart failure with reduced ejection fraction, and hence, there is limited evidence in patients of heart failure with preserved ejection fraction (HFpEF). This study was conducted to clarify the relationship between serum chloride level and clinical outcomes in patients with HFpEF with acute decompensated heart failure (ADHF).

Patient data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, a prospective multicentre observational registry for ADHF‐HFpEF in Osaka. The data of 870 patients were analysed after excluding patients with in‐hospital death, missing follow‐up data, missing data of serum chloride level, or on chronic dialysis therapy. The primary endpoint of this study was all‐cause mortality. At discharge, right ventricular systolic dysfunction was significantly associated with the lowest tertile of serum chloride level after multivariable adjustment (P = 0.0257). During a mean follow‐up period of 1.8 ± 1.0 years, 186 patients died. Cox multivariable analysis showed that serum chloride level at discharge (P = 0.0017) was independently associated with all‐cause mortality after multivariable adjustment of major confounders, whereas serum sodium level was no longer significant (P = 0.6761). Kaplan–Meier survival curve analysis revealed a significantly increased risk of mortality stratified by the tertile of serum chloride level [29% vs. 19% vs. 16%, P = 0.0002; hazard ratio (HR): 2.09 (95% confidence interval, CI: 1.31 to 3.34), HR: 1.03 (95% CI: 0.65 to 1.64)].

Serum chloride level was useful for the prediction of poor outcome in ADHF patients with preserved ejection fraction.

• Heart failure with preserved ejection fraction
• Risk stratification
• Serum chloride level

• Clinical data exchange
• Data systems
• Electronic medical records
• Medical informatics applications
• Observational study

• Computers
• Data Management
• Electronic Health Records
• Hospitals
• Humans

• Acute decompensated heart failure
• Body mass index
• Heart failure with preserved ejection fraction
• Obesity paradox

At present, the clinical significance of admission hyperglycaemia in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. This study was designed to evaluate the relationship between admission hyperglycaemia and clinical outcome in HFpEF patients, especially in non‐diabetic patients.

We enrolled 486 non‐diabetic HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT‐HFpEF registry, a prospective, multicentre observational study. We divided non‐diabetic patients into two groups, an admission hyperglycaemia group whose blood glucose on admission was ≥7.0 mmol/L (148 patients) and a normoglycaemic group whose blood glucose on admission was <7.0 mmol/L (338 patients). The primary endpoint was all‐cause mortality, and the secondary endpoints were heart failure death and other causes of cardiac death. During a mean follow‐up period of 400 ± 335 days, all‐cause mortality was 69 patients. Twenty‐five patients suffered cardiac death. All‐cause mortality (P = 0.002), cardiac death (P = 0.009), and heart failure death (P = 0.001) were significantly more frequent in the admission hyperglycaemia group than in the normoglycaemic group. Admission hyperglycaemia was independently and significantly associated with all‐cause mortality and cardiac death (HR 2.01, 95% CI 1.20–3.34, P = 0.008 and HR 3.03, 95% CI 1.35–6.96, P = 0.007, respectively).

Non‐diabetic HFpEF patients with admission hyperglycaemia when hospitalized for heart failure had poorer clinical outcomes than normoglycaemic patients.

• Admission blood glucose
• Heart failure with preserved ejection fraction
• Hyperglycaemia
• Prognosis

Frailty is associated with prognosis of cardiovascular diseases. However, the significance of frailty in patients with heart failure with preserved ejection fraction (HFpEF) remains to be elucidated. The purpose of this study was to examine the prognostic significance of the Clinical Frailty Scale (CFS) in real‐world patients with HFpEF using data from a prospective multicentre observational study of patients with HFpEF (PURSUIT‐HFpEF study).

We classified 842 patients with HFpEF enrolled in the PURSUIT‐HFpEF study into two groups using CFS. The registry enrolled patients hospitalized with a diagnosis of decompensated heart failure. Median age was 82 [interquartile range: 77, 87], and 45% of the patients were male. Of 842 patients, 406 were classified as high CFS (CFS ≥ 4, 48%) and 436 as low CFS (CFS ≤ 3, 52%). The primary endpoint was the composite of all‐cause mortality and heart failure admission. Secondary endpoints were all‐cause mortality and heart failure admission. Patients with high CFS were older (85 vs. 79 years, P < 0.001), predominantly female (65% vs. 46%, P < 0.001) and more likely to have New York Heart Association (NYHA) ≥ 2 (75% vs. 53%, P < 0.001) and a higher level of NT‐proBNP (1360 vs 838 pg/mL, P < 0.001) than those with low CFS. Patients with high CFS had a significantly greater risk of composite endpoint (Kaplan–Meier estimated 1‐year event rate 39% vs. 23%, log‐rank P < 0.001), all‐cause mortality (Kaplan–Meier estimated 1‐year event rate 17% vs. 7%, log‐rank P < 0.001) and heart failure admission (Kaplan–Meier estimated 1‐year event rate 28% vs. 19%, log‐rank P = 0.002) than those with low CFS. Multivariable Cox regression analysis revealed that high CFS was significantly associated with composite endpoint (adjusted HR 1.92, 95% CI 1.35–2.73, P < 0.001), all‐cause mortality (adjusted HR 2.54, 95% CI 1.39–4.66, P = 0.003) and heart failure admission (adjusted HR 1.55, 95% CI 1.03–2.32, P = 0.035) even after adjustment for covariates. Moreover, change in CFS grade was also significantly associated with composite endpoint (adjusted HR 1.23, 95% CI 1.11–1.36, P < 0.001), all‐cause mortality (adjusted HR 1.32, 95% CI 1.13–1.55, P = 0.001) and heart failure admission (adjusted HR 1.15, 95% CI 1.02–1.30, P = 0.021).

Frailty assessed by the CFS was associated with poor prognosis in patients with HFpEF.

• Frailty; Heart failure with preserved ejection fraction; Clinical Frailty Scale

• Cholinesterase
• Heart failure
• Liver
• Prognosis

• Acute Disease
• Biomarkers
• Cholinesterases
• Heart Failure/diagnosis
• Humans
• Natriuretic Peptide, Brain
• Patient Discharge
• Prognosis

• Heart failure with preserved ejection fraction
• High density lipoprotein cholesterol/C reactive protein ratio
• Inflammation
• Left ventricular diastolic function
• Right ventricular systolic function

• Albumin
• Cholinesterase
• Death
• Exercises

With the prevalence of cardiovascular diseases increasing worldwide, early prediction and accurate assessment of heart failure (HF) risk are crucial to meet the clinical demand.

Our study objective was to develop machine learning (ML) models based on real-world electronic health records to predict 1-year in-hospital mortality, use of positive inotropic agents, and 1-year all-cause readmission rate.

For this single-center study, we recruited patients with newly diagnosed HF hospitalized between December 2010 and August 2018 at the First Affiliated Hospital of Dalian Medical University (Liaoning Province, China). The models were constructed for a population set (90:10 split of data set into training and test sets) using 79 variables during the first hospitalization. Logistic regression, support vector machine, artificial neural network, random forest, and extreme gradient boosting models were investigated for outcome predictions.

Of the 13,602 patients with HF enrolled in the study, 537 (3.95%) died within 1 year and 2779 patients (20.43%) had a history of use of positive inotropic agents. ML algorithms improved the performance of predictive models for 1-year in-hospital mortality (areas under the curve [AUCs] 0.92-1.00), use of positive inotropic medication (AUCs 0.85-0.96), and 1-year readmission rates (AUCs 0.63-0.96). A decision tree of mortality risk was created and stratified by single variables at levels of high-sensitivity cardiac troponin I (<0.068 μg/L), followed by percentage of lymphocytes (<14.688%) and neutrophil count (4.870×10⁹/L).

ML techniques based on a large scale of clinical variables can improve outcome predictions for patients with HF. The mortality decision tree may contribute to guiding better clinical risk assessment and decision making.

• heart failure
• machine learning
• mortality
• positive inotropic agents
• predictive modeling
• readmission