Pentraxin-3 as a novel biomarker to monitor disease progress and treatment response in patients with heart failure

Background Heart failure (HF) is a complex clinical syndrome with poor outcomes that occurs at the end stage of heart disease. Left ventricular ejection fraction (LVEF) improvement in individuals with HF with reduced ejection fraction (HFrEF) reflect the observable traits that are a consequence of treatment and management. Pentraxin-3 (PTX3) is a biomarker elevated in individuals with HF due to chronic inflammation and endothelial dysfunction. Purpose The aim of this study was to evaluate PTX3 as a potential biomarker for monitoring disease progress and treatment response in patients with HFrEF and its association with clinical factors. Methods Data collected from BIOSTAT-CHF consists of patients with LVEF ≤40% at baseline who had a LVEF re-assessed at 9 months. A LVEF >40% and a LVEF ≥10% rise from baseline at 9 months were defined as HF with improved ejection fraction (HFimpEF). Plasma PTX3 concentrations were performed in patients with HF at baseline and 9 months of follow up using an Alere assay. Statistical analysis was performed to compare PTX3 levels between HFimpEF and persistent HFrEF group with adjustment for age, sex, ischemic heart disease, systolic blood pressure, diabetes mellitus and eGFR. In addition, the relationship between PTX3 levels and clinical variables were assessed. Results Plasma PTX3 concentrations were measured in a total of 826 patients with HF in the BIOSTAT-CHF project that was categorised into HFimpEF (n=152, 18.4%) and persistent HFrEF (n=674, 81.6%). At baseline, PTX3 concentrations for HFimpEF were higher than HFrEF (0.28 ± 0.34 vs. 0.24 ± 0.34 ng/mL), but without a significant adjusted p-value of 0.387. At 9 months of follow up, PTX3 levels in patients with HFimpEF were significantly lower as compared to those with persistent HFrEF (0.16 ± 0.29 vs.0.26 ± 0.29 ng/mL, adjusted p=0.006). In addition, PTX3 levels were positively correlated with NT pro-BNP (p<0.001) and inversely correlated with LVEF (p<0.0001), eGFR (p<0.0001) and platelet count (p=0.003). Conclusions Plasma PTX3 concentrations were lower in patients with HFimpEF as compared to those with persistent HFrEF. Higher plasma concentrations of PTX3 might reflect an improvement in inflammation and remodelling in patients with HF. This suggests that PTX3 could serve as a biomarker for monitoring disease progress and treatment response in patients with HFrEF. Additionally, PTX3 may provide a more objective alternative for tracking HF patient progress rather than relying on reproducible LVEF measurements. Further investigations using different cohorts should be performed to confirm its results for clinical utility.PTX3 levels:HFimpEF vs. persistent HFrEF Heatmap of correlations for PTX3 levels