Inflammation across universal definition of heart failure stages: the CASABLANCA study

Area of Science:

• Cardiology
• Biomarkers
• Inflammation Research

Background:

• Heart failure (HF) is a complex condition with various contributing factors.
• Inflammatory biomarkers play a role in cardiovascular disease pathogenesis.
• Understanding inflammation's impact across HF stages is crucial for risk stratification.

Purpose of the Study:

• To investigate the association between inflammatory biomarkers and incident heart failure (HF) events.
• To analyze these associations across different stages of HF, from at-risk to end-stage.
• To determine if inflammation severity has differing prognostic implications based on HF stage.

Main Methods:

• 1231 patients undergoing angiography were categorized by Universal Definition of HF (UDHF) stages A, B, C, or D.
• Twenty-four inflammatory biomarkers were measured.
• Unsupervised machine learning classified inflammation into low, medium, and high groups.
• Cox proportional hazard regression assessed HF hospitalization risk across inflammation levels and HF stages.

Main Results:

• High inflammation levels were associated with significantly higher concentrations of natriuretic peptide, troponin, and soluble ST2.
• Over 3.7 years, HF hospitalizations occurred in 15.1% of stage A/B patients and 41.8% of stage C/D patients.
• In stage A/B patients, moderate and high inflammation increased HF risk by 2.31 and 4.16 times, respectively.
• In stage C/D patients, moderate and high inflammation increased HF hospitalization risk by 1.98 and 2.69 times, respectively.

Conclusions:

• Inflammation severity is significantly associated with incident heart failure (HF) events across all UDHF stages.
• Higher inflammation levels correlate with increased risk for HF hospitalization, particularly in earlier stages.
• Prognostic meaning of inflammation severity differs across UDHF stages, emphasizing its clinical relevance.