Biomarker Profiles in Heart Failure Patients With Preserved and Reduced Ejection Fraction

Abstract

Background Biomarkers may help us to unravel differences in the underlying pathophysiology between heart failure ( HF ) patients with a reduced ejection fraction ( HF r EF ) and a preserved ejection fraction ( HF p EF ). Therefore, we compared biomarker profiles to characterize pathophysiological differences between patients with HF r EF and HF p EF . Methods and Results We retrospectively analyzed 33 biomarkers from different pathophysiological domains (inflammation, oxidative stress, remodeling, cardiac stretch, angiogenesis, arteriosclerosis, and renal function) in 460 HF patients (21% HF p EF , left ventricular ejection fraction ≥45%) measured at discharge after hospitalization for acute HF . The association between these markers and the occurrence of all‐cause mortality and/or HF ‐related rehospitalizations at 18 months was compared between patients with HF r EF and HF p EF . Patients were 70.6±11.4 years old and 37.4% were female. Patients with HF p EF were older, more often female, and had a higher systolic blood pressure. Levels of high‐sensitive C‐reactive protein were significantly higher in HF p EF , while levels of pro‐atrial‐type natriuretic peptide and N‐terminal pro‐brain natriuretic peptide were higher in HF r EF . Linear regression followed by network analyses revealed prominent inflammation and angiogenesis‐associated interactions in HF p EF and mainly cardiac stretch–associated interactions in HF r EF . The angiogenesis‐specific marker, neuropilin and the remodeling‐specific marker, osteopontin were predictive for all‐cause mortality and/or HF ‐related rehospitalizations at 18 months in HF p EF , but not in HF r EF ( P for interaction <0.05). Conclusions In HF p EF , inflammation and angiogenesis‐mediated interactions are predominantly observed, while stretch‐mediated interactions are found in HF r EF . The remodeling marker osteopontin and the angiogenesis marker neuropilin predicted outcome in HF p EF , but not in HF r EF .