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The Role of Myocardial Fibrosis and Bioenergetic Dysfunction in Heart Failure Prognosis: A Study Protocol

Mário Barbosa1, Ana Melicio2, Ana Matias3

  • 1Department of Internal Medicine, Hospital Lusíadas Lisboa, Lisbon, PRT.

Cureus
|December 8, 2025
PubMed

Insights

This study investigates how heart failure biomarkers like galectin-3 and iron deficiency impact patient outcomes. Identifying these markers can help predict short-term prognosis for acute decompensated heart failure patients.

Area of Science:

  • Cardiology
  • Biomarkers
  • Heart Failure Pathophysiology

Background:

  • Standard heart failure (HF) treatments target the renin-angiotensin-aldosterone and sympathetic nervous systems.
  • Myocardial fibrosis and bioenergetic dysfunction are increasingly recognized as critical factors in HF development and progression.

Purpose of the Study:

  • To stratify the short-term outcomes of hospitalized patients with acute decompensated heart failure (ADHF) in New York Heart Association (NYHA) class III or IV.
  • To assess the prognostic value of myocardial fibrosis biomarkers (galectin-3, ST2, GDF-15) and iron deficiency (absolute and functional).

Main Methods:

  • A prospective, observational, unicentric cohort study with 128 participants divided into two groups based on left ventricular ejection fraction (LVEF > 40% and ≤ 40%).
  • Serum and plasma levels of galectin-3 (Gal-3), ST2, and growth differentiation factor-15 (GDF-15) were measured.
  • Iron kinetics were evaluated in plasma, and statistical analyses included Kaplan-Meier estimates and Cox proportional hazards models.

Main Results:

  • The study anticipates establishing a correlation between elevated fibrosis biomarkers and iron deficiency with poorer short-term outcomes in ADHF patients.
  • Analysis will focus on predicting early HF readmission, all-cause mortality (up to 90 days and annually), and major adverse cardiovascular events (MACE).

Conclusions:

  • This research aims to enhance understanding of how myocardial fibrosis and bioenergetic dysfunction influence the short-term prognosis of heart failure.
  • Findings may guide risk stratification and personalized treatment strategies for ADHF patients.

Keywords:
bioenergetic dysfunctiongalectin-3gdf-15heart failurest2

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