Phenotypic Features of Heart Failure in Patients with Preserved Left Ventricular Ejection Fraction

Aim    Chronic heart failure with preserved left ventricular ejection fraction (CHFpEF) is characterized by high prevalence, clinical heterogeneity, and insufficient understanding of its mechanisms compared to other CHF types. One approach to improving the patient group stratification is the identification of subphenotypes based on clinical and functional data and biomarker assessment. The aim of this study was to identify the clinical, laboratory, and instrumental characteristics of patients with CHFpEF and ischemic heart disease based on left ventricular ejection fraction (LVEF).Material and methods     This study included 145 patients with CHFpEF who were scheduled for coronary artery bypass grafting. Inclusion criteria were NYHA class ≥2 symptomatic heart failure, preserved LVEF ≥50%, and a HFA-PEFF algorithm total score ≥3, which helps diagnose CHFpEF. Patients were divided into a group with LVEF 50-60% (group 1; n=53) and a group with LVEF >60% (group 2; n=92). Before surgery, echocardiography, standard laboratory tests, and measurements of plasma biomarkers (N-terminal pre-brain natriuretic peptide (NT-proBNP), vascular endothelial growth factor (VEGF), heart fatty acid binding protein (H-FABP), interleukin receptor ST2, vascular endothelial cell adhesion molecule (VCAM), plasminogen activator inhibitor type 1 (PAI-1), neuropilin-1 (NRP-1) were performed in all patients.Conclusion    CHFpEF subphenotypes have different clinical and laboratory characteristics. Higher neuropilin-1 concentrations were associated with lower LVEF in CHFpEF.