Heart failure & cardiomyopathiesResearch article
Novel biomarkers distinguish heart failure with preserved vs reduced ejection fraction
- Exploratory biomarker study
- 19 plasma biomarkers including seven novel research assays
- hypothesis-generating
Authors' conclusion
Among seven novel biomarker assays, higher MYBPC3 (reflecting muscle injury and myopathy) and FGF23 (endothelial dysfunction, oxidative stress) distinguished HFrEF from HFpEF. Higher MYBPC3 was most prognostic in HFrEF while higher ANGPT2 and IGFBP7 (endothelial dysfunction and oxidative stress) in HFpEF. These hypothesis-generating findings support primary cardiomyocyte injury as a driver of HFrEF and systemic inflammation and oxidative stress as a driver of HFpEF.
Study context
- Population
- Patients with heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fractionHFpEF 76 · HFrEF 36
- Participants
- 36 vs 76
- Comparison
- HFrEF vs HFpEF
- HFrEFn = 36
- HFpEFn = 76
Main finding
As reported in the abstract
Female
years
| Outcome | HFpEF | HFrEF |
|---|---|---|
| Age | 73 | 63 |
Further findings
Outcome (HFpEF: all-cause death, heart failure (HF) hospitalization; HFrEF: all-cause death, LVAD or heart transplantation)
| Comparison | HR | |
|---|---|---|
| ANGPT2 · more strongly in HFpEF | 1.45 (95% CI 1.00–2.13) | |
| IGFBP7 · more strongly in HFrEF | 2.51 (CI 0.95–6.64) | |
| MYBPC3 | 1.62 (CI 0.99–2.64) | |
| 0.10.31310Hazard ratio (log scale) |
Novel biomarker levels
- All seven novel biomarkers except FABP3 tended to be higher in HFrEF vs HFpEF and associated with worse NYHA class and lower eGFR in both LVEF categories
Discrimination between LVEF categories
- MYBPC3 AUC
- 85.8
- FGF23 AUC
- 80.0
- MYBPC3 and FGF23 higher in HFrEF
Associations with cardiac function in HFpEF
- ANGPT2 and TAPSE β
- −1.03
- ANGPT2 and LV-GLS β
- 1.29
- ANGPT2 and LA-GLS β
- 5.03
- IGFBP7 and E/eʹ β
- 4.09
- MYBPC3 and E/eʹ β
- 1.36
- TAPSE P = .04
- LV-GLS P = .03
- LA-GLS P < .001
- IGFBP7 E/eʹ P = .02
- MYBPC3 E/eʹ P = .01
Outcome (HFpEF: all-cause death, HF hospitalization; HFrEF: all-cause death, LVAD or heart transplantation)
- All biomarkers except DKK3 were positively associated with the outcome
Original publication
Summarised from the published abstract; every number is checked against it