Biomarkers Correspond with Echocardiographic Phenotypes in Heart Failure with Preserved Ejection Fraction: A...

Area of Science:

• Cardiology
• Biomarkers
• Heart Failure Research

Background:

• The relationship between structural phenotypes and cardiac biomarkers in heart failure with preserved ejection fraction (HFpEF) is not well understood.
• Identifying distinct HFpEF phenotypes is crucial for understanding disease heterogeneity and developing targeted treatments.

Approach:

• Latent class analysis (LCA) was used on echocardiographic data from 216 HFpEF patients in the RELAX trial.
• Echocardiographic parameters included left atrial enlargement (LAE), diastolic dysfunction (DD), E/e', ejection fraction (EF) ≤55%, and right ventricular dysfunction.
• Three distinct structural HFpEF phenotypes were identified.

Key Points:

• Phenotype B exhibited severe diastolic dysfunction, left atrial enlargement, elevated E/e', and right ventricular dysfunction.
• Phenotype C showed moderate LAE and less diastolic dysfunction, while Phenotype A had the least severe diastolic dysfunction.
• Phenotypes B and C were associated with higher prevalence of atrial fibrillation (AF).
• Phenotype B demonstrated elevated levels of carboxy-terminal telopeptide of collagen type I (CITP), cystatin-c (CYSTC), endothelin-1 (ET1), NT-proBNP, and high-sensitivity troponin I (TNI).
• Phenotype A had higher CITP and CYSTC, while Phenotype C had elevated NT-proBNP.

Conclusions:

• Distinct structural HFpEF phenotypes are associated with specific cardiac biomarker profiles.
• These findings suggest phenotype-specific pathophysiology in HFpEF.
• Understanding these phenotype-biomarker relationships may inform prognosis and guide targeted therapeutic strategies for HFpEF.