Key result
Higher plasma Tenascin-C levels in HFpEF patients were independently associated with an increased risk of all-cause death or heart failure hospitalization (HR 1.755; 95% CI 1.305–2.360; p<0.0001).
Why the study?
It was unknown whether plasma Tenascin-C, a marker of interstitial fibrosis, differs between HFpEF and asymptomatic controls and relates to clinical outcomes.
Does plasma Tenascin-C level predict the composite of all-cause death or heart failure hospitalization in patients with HFpEF?
Observational (n=172)
Does plasma Tenascin-C level predict the composite of all-cause death or heart failure hospitalization in patients with HFpEF?
Effect estimate: HR 1.755 (95% CI 1.305–2.360)
p-value: p=< 0.0001
Plasma Tenascin-C is elevated in HFpEF compared to controls and serves as a strong independent predictor of all-cause death or heart failure hospitalization.
Tenascin-C may refine HFpEF prognosis; hypothesis-generating and requires prospective validation before clinical adoption.
Introduction Tenascin-C is a marker of interstitial fibrosis. We assessed whether plasma Tenascin-C differed between heart failure with preserved ejection fraction (HFpEF) and asymptomatic controls and related to clinical outcomes.Materials and Methods Prospective, observational study of 172 age- and sex-matched subjects (HFpEF n = 130; controls n = 42, age 73 ± 9, males 50%) who underwent phenotyping with 20 plasma biomarkers, echocardiography, cardiac MRI and 6-minute-walk-testing. The primary endpoint was the composite of all-cause death/HF hospitalisation.Results Tenascin-C was higher in HFpEF compared to controls (13.7 [10.8–17.3] vs (11.1 [8.9–12.9] ng/ml, p < 0.0001). Tenascin-C correlated positively with markers of clinical severity (NYHA, E/E’, BNP) and plasma biomarkers reflecting interstitial fibrosis (ST-2, Galectin-3, GDF-15, TIMP-1, TIMP-4, MMP-2, MMP-3, MMP-7, MMP-8), cardiomyocyte stress (BNP, NTpro-ANP), inflammation (MPO, hs-CRP, TNFR-1, IL6) and renal dysfunction (urea, cystatin-C, NGAL); p < 0.05 for all.During follow-up (median 1428 days), there were 61 composite events (21 deaths, 40 HF hospitalizations). In multivariable Cox regression analysis, Tenascin-C (adjusted hazard ratio [HR] 1.755, 95% confidence interval [CI] 1.305–2.360; p < 0.0001) and indexed extracellular volume (HR 1.465, CI 1.019–2.106; p = 0.039) were independently associated with adverse outcomes.Conclusions In HFpEF, plasma Tenascin-C is higher compared to age- and sex-matched controls and a strong predictor of adverse outcomes. Trial registration: ClinicalTrials.gov: NCT03050593
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Kanagala et al. (2020) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=172). Plasma Tenascin-C vs. Asymptomatic controls was evaluated on Composite of all-cause death/HF hospitalisation (HR 1.755, 95% CI 1.305–2.360, p=< 0.0001). Higher plasma Tenascin-C levels in HFpEF patients were independently associated with an increased risk of all-cause death or heart failure hospitalization (HR 1.755; 95% CI 1.305–2.360; p<0.0001).
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