Urinary Proteomics and Outcomes in Heart Failure With Preserved Ejection Fraction.

Area of Science:

• Cardiology
• Proteomics
• Biomarker Discovery

Background:

• Limited data exists on urinary proteomics for predicting outcomes in heart failure with preserved ejection fraction (HFpEF).
• Plasma proteomics studies in HFpEF are more established than urinary analyses.

Purpose of the Study:

• To identify urinary proteins/peptides associated with mortality and heart failure hospitalizations in HFpEF patients.
• To evaluate the prognostic value of urinary proteomics in HFpEF.

Main Methods:

• Analysis of data from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT).
• Cox regression models were used to assess the relationship between urine protein levels and adverse outcomes.
• Analyses were performed both unadjusted and adjusted for urine creatinine and the MAGGIC score.

Main Results:

• 426 participants with available urinary protein data were included.
• 40 urinary proteins/peptides showed significant association with death or HF admission in unadjusted analyses; 21 remained significant after adjustment.
• Higher levels of urinary proteins involved in fibrosis, metabolism, and inflammation were associated with a lower risk of adverse events.

Conclusions:

• Novel associations between urinary proteins/peptides and outcomes in HFpEF were identified.
• These associations are largely independent of established clinical risk scores.
• Urinary proteomics may offer a valuable tool for risk stratification in HFpEF.