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. 2024 Jan 16;24(1):35.
doi: 10.1186/s12890-024-02856-7.

Circulating acetylcholine serves as a potential biomarker role in pulmonary hypertension

Yicheng Yang #  1   2 , Jing Xu #  2 , Songren Shu  3 , Peizhi Wang  2 , Yanru Liang  1 , Bingyang Liu  1 , Beilan Yang  1 , Hanwen Zhang  1 , Qing Zhao  1 , Zhihui Zhao  1 , Qin Luo  1 , Zhihong Liu  1 , Qixian Zeng  4 , Changming Xiong  5
Affiliations

Circulating acetylcholine serves as a potential biomarker role in pulmonary hypertension

Yicheng Yang et al. BMC Pulm Med. .

Abstract

Background: An increased acetylcholine (ACh) level in the right ventricle tissue of pulmonary hypertension (PH) was revealed, which indicated the important role of ACh in disease pathogenesis. However, the relationship between plasma ACh levels and disease conditions and patients' prognosis has not been investigated. We aimed to explore the association between plasma ACh levels and the prognosis of patients with PH. We also discussed the feasibility of plasma ACh as a biomarker, which may contribute to the management of PH patients in the future.

Methods: Patients with confirmed PH in Fuwai Hospital from April 2019 to August 2020 were enrolled. The primary clinical outcome in this study was defined as a composite outcome, including death/lung transplantation, heart failure, and worsening of symptoms. Fasting plasma was collected to detect the ACh levels. The association between ACh levels and patients' prognosis was explored.

Results: Finally, four hundred and eight patients with PH were enrolled and followed for a mean period of 2.5 years. Patients in the high ACh group had worse World Health Organization Functional Class (WHO-FC), lower 6-minute walk distance (6 MWD), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP). Notably, echocardiographic and hemodynamic parameters in the high metabolite group also suggested a worse disease condition compared with the low ACh group. After adjusting for confounders, compared with low ACh patients, those with high metabolite levels still have worse prognoses characterized as elevated risk of mortality, heart failure, and symptoms worsening.

Conclusion: High circulating ACh levels were associated with severe PH conditions and poor prognosis, which might serve as a potential biomarker in PH.

Keywords: Acetylcholine; Biomarker; Metabolite; Prognosis; Pulmonary hypertension.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Restricted cubic spline result of Acetylcholine levels with hazard ratios for the risk of primary outcome (A), death (B), heart failure (C), and symptoms worsening (D). HR: hazard ratio; CI: confidence interval
Fig. 2
Fig. 2
Kaplan-Meier analysis for the incidence of composite outcome events (A), death (B), heart failure (C), and symptoms worsening (D) in patients with high and low acetylcholine levels. Four hundred and eight patients with PH were analyzed (n = 203 in the high acetylcholine group; n = 205 in the low acetylcholine group). P-value calculated by the log-rank test
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