Abstract 20967: Decreased Arylesterase Activity is Associated with Adverse Outcomes in Outpatients with Heart Failure
Introduction: Decreased arylesterase (ArylE) activity of paraoxonase-1, a HDL-associated protein with anti-inflammatory and antioxidant properties, has been associated with increased risk for cardiac events and heart failure (HF) in patients with coronary artery disease (CAD). However, the structural correlates and prognostic value of ArylE in patients with prevalent HF have not been reported.
Methods: We examined the association between baseline serum ArylE activity and outcomes (death, cardiac transplantation, ventricular assist device implantation, or all-cause hospitalization) in 175 outpatients with HF enrolled in a prospective cohort study in the metropolitan Atlanta GA area from 1/2008 to 7/2009. Structural heart characteristics were assessed by echocardiography.
Results: Mean age was 57.5±11.8 years; 62.9% were male; 58.1% were white and 36.8% black; 38.9% had CAD and 34.3% had diabetes. Left ventricular (LV) ejection fraction was 39.6±14.5%, LV diastolic diameter 59±10 mm, left atrial (LA) diameter 43±5 mm, and LV mass 267±88 g. Mean ArylE activity was 112±28 μmol/min/ml. ArylE was negatively correlated with LA diameter (ρ=-0.25; p=0.004) and LV mass (ρ=-0.21; p=0.019). On follow-up (median: 19 months), 59 patients (33.7%) experienced an event. Patients with ArylE in the lowest (83±14 μmol/min/ml) and middle (110±6 μmol/min/ml) tertiles had increased risk for adverse events (HR: 3.91; 95% CI: 1.91–8.01; p<0.001; and HR: 2.14; 95% CI: 1.00–4.61; p=0.051, respectively) compared to those in the highest tertile (143±18 μmol/min/ml) (Figure 1). This association persisted when adjusting for age, gender, race, smoking, diabetes, CAD, creatinine, LV mass, and LA diameter (HR: 7.29; 95% CI: 2.00–26.6; p=0.003 and HR: 5.08; 95% CI: 1.41–18.3; p=0.013 for the lowest and middle vs. highest tertile, respectively).
Conclusions: Reduced ArylE activity is associated with atrial and ventricular remodeling and adverse outcomes in stable outpatients with HF.
- © 2010 by American Heart Association, Inc.