Biomarker Profiles of Acute Heart Failure Patients With a Mid-Range Ejection Fraction

Area of Science:

• Cardiology
• Biomarker Research
• Heart Failure Pathophysiology

Background:

• Limited data exist on biomarker profiles in acute heart failure with midrange ejection fraction (HFmrEF).
• Understanding these profiles is crucial for differentiating HFmrEF from heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

• To characterize biomarker profiles in acute HFmrEF patients.
• To compare these profiles with those in acute HFrEF and HFpEF.
• To investigate the relationship between biomarker profiles and clinical outcomes.

Main Methods:

• Analysis of 37 biomarkers from various pathophysiological domains in 843 acute heart failure patients from the PROTECT trial.
• Classification of patients into HFpEF (LVEF ≥50%), HFrEF (LVEF <40%), and HFmrEF (LVEF 40%–49%).
• Biomarker levels measured at admission and 24 hours, with network analysis and outcome prediction.

Main Results:

• Hemoglobin and brain natriuretic peptide levels showed an upward trend with decreasing LVEF.
• HFrEF biomarker interactions were linked to cardiac stretch; HFpEF interactions were linked to inflammation.
• HFmrEF patients exhibited intermediate biomarker interactions involving both cardiac stretch and inflammation.

Conclusions:

• Acute HFrEF biomarker profiles are primarily associated with cardiac stretch, while HFpEF profiles are linked to inflammation.
• HFmrEF patients present an intermediate profile, with interactions between cardiac stretch and inflammation markers.
• Remodeling and inflammatory markers predict mortality and rehospitalization in HFpEF and HFmrEF, but not HFrEF.