Cardioimmunologic response patterns after an acute heart failure event: Design and first results of AHF-ImmunoCS

We have previously shown that patients who develop heart-reactive antibodies (HRAs) de novo after a heart failure (HF) hospitalization are at increased risk of adverse outcomes, lending weight to the hypothesis that B cells may play a pivotal role in HF progression. We therefore aim to further elucidate the adaptive immune response to an acute HF event, with a particular focus on the factors that lead to incident HRAs and their relation to worsening cardiac function and prognosis.

The Acute Heart Failure Immunomonitoring Cohort Study (AHF-ImmunoCS) is a prospective monocentric cohort study. Patients are enrolled consecutively during hospitalization for AHF and undergo detailed phenotyping at baseline and at 6-week, 6-, 12- and 18-month follow-up visits. Patient sera are screened for HRAs by immunofluorescence testing (IFT) as well as by using defined cardiac antigens immobilized on beads. By 31 December 2023, we had included 259: 38% women, mean age 72 (SD 13) years, 37% de novo HF, median left ventricular ejection fraction 50 (quartiles 35, 56) %. Preliminary data of the first 59 patients (42% women, mean 72 (14) years) showed that 80% of patients exhibiting seroconversion had done so within 6 weeks.

AHF-ImmunoCS is enrolling a representative cohort of HF patients. Our preliminary data confirm that seroconversion to HRAs occurs early after hospitalization for HF in a subgroup of patients. The full study can be expected to clarify how changes in HRA profiles relate to prognosis and may pave the way for novel immunotherapeutic approaches to acute heart failure.