Serum soluble transferrin receptor (sTfR) in HFpEF: associations with cardiac function and exercise tolerance

To investigate the potential links between soluble transferrin receptor (sTfR), the monocyte/HDL cholesterol ratio (MHR), and heart failure with preserved ejection fraction (HFpEF), in order to provide new biomarkers for clinical evaluation of HFpEF and new ideas for disease treatment.

66 patients diagnosed with HFpEF who visited the cardiology department of Cangzhou Central Hospital from January 2023 to October 2023 were selected as the study group, and 70 healthy participants from concurrent physical examinations at the hospital's examination center were designated as controls. Record demographic data, hematological/biochemical parameters (including sTfR, MHR), and echocardiographic measures of cardiac structure and function. Compare these indices between groups to assess for statistically significant differences. Conduct a multi-factor analysis of the risk factors obtained from the single factor analysis above to explore the independent risk factors of HFpEF. Conduct subgroup analysis on the research group to explore the correlation between sTfR and cardiac structure, function, and activity tolerance in HFpEF patients. Follow up with the patients in the research group for 1 year and analyze their prognosis.

Female representation (69.7% vs 51.4%), left atrial diameter (37.52 ± 3.57 mm vs 35.04 ± 2.83 mm), and sTfR [3.29 (2.76, 3.57) mg/L vs 2.43 (2.08, 2.78) mg/L] were significantly greater in the study group compared to the control group across both cohorts (P < 0.05); There were no significant intergroup differences in terms of age, demographic and clinical histories (smoking, alcohol use, hypertension, diabetes), blood lipid profile, hepatic and renal function, other biochemical parameters, or MHR (P > 0.05 for all). Multivariable analysis identified sTfR (OR 1.293, P = 0.012) and LAD (OR 15.229, P < 0.01) as independent risk factors for HFpEF. Their predictive performance, assessed by ROC curve analysis, yielded AUC values of 0.835 for sTfR and 0.609 for LAD. The corresponding optimal diagnostic thresholds for predicting HFpEF were 3.05 mg/L and 37.5 mm, respectively. Subgroup analysis revealed significantly higher BNP and LAD, but lower 6MWT, in patients with high versus low sTfR expression (all P < 0.05). Over the 1-year follow-up, cumulative event-free survival did not differ significantly between patients with high versus low sTfR expression (median 11.17 vs. 11.65 months; Log-Rank χ² = 0.174, P = 0.676).

Serum sTfR correlates with HFpEF severity and prognosis, offering a potential biomarker for disease assessment and outcome prediction.