IGFBP-7 and Outcomes in Heart Failure With Reduced Ejection Fraction: Findings From DAPA-HF

Area of Science:

• Cardiology
• Biomarkers
• Heart Failure Research

Background:

• Insulin-like growth factor-binding protein-7 (IGFBP-7) is a potential prognostic biomarker in heart failure (HF).
• The prognostic value of elevated IGFBP-7 in ambulant patients with heart failure with reduced ejection fraction (HFrEF) remained unclear.

Purpose of the Study:

• To investigate the association between IGFBP-7 levels and adverse outcomes in HFrEF patients.
• To assess whether IGFBP-7 modifies the treatment effect of dapagliflozin in HFrEF.

Main Methods:

• Post hoc analysis of the DAPA-HF trial involving 3,158 patients with baseline IGFBP-7 measurements.
• Primary outcome: composite of cardiovascular death or worsening heart failure events.
• Cox proportional hazard models adjusted for NT-proBNP and hsTnT; treatment efficacy assessed across IGFBP-7 tertiles.

Main Results:

• Patients in the highest IGFBP-7 tertile exhibited more advanced HFrEF.
• Elevated IGFBP-7 (tertile 3 vs. tertile 1) was associated with a 48% increased risk of adverse outcomes (aHR: 1.48; 95% CI: 1.17-1.88).
• Dapagliflozin's benefit was not modified by baseline IGFBP-7 levels (P interaction = 0.34).

Conclusions:

• Higher IGFBP-7 levels in HFrEF patients correlate with a poorer clinical profile and increased risk of adverse events.
• IGFBP-7 provides prognostic information incremental to clinical factors, NT-proBNP, and hsTnT.
• IGFBP-7 levels did not influence the efficacy of dapagliflozin treatment.