The Association Between Serially Measured Circulating Biomarker Patterns and Pulmonary Artery Pressures Measured by Invasive Hemodynamic Monitoring

BACKGROUND: Invasive hemodynamic monitoring devices provide relevant insights into the hemodynamic status of heart failure (HF) patients. Additionally, circulating biomarkers have been advocated as additives in HF management by offering prognostic information and therapeutic targets. However, limited data exist correlating serially measured biomarkers to hemodynamic pressures provided by invasive sensors. This study aims to investigate the association between serial biomarker patterns and pulmonary artery (PA) pressure dynamics in HF patients. METHODS AND RESULTS: This study is a substudy of MONITOR-HF (Remote Haemodynamic Monitoring of Pulmonary Artery Pressures in Patients With Chronic Heart Failure) (NTR7673), a prospective investigator-initiated multicenter randomized clinical trial conducted in chronic HF (CHF) patients. Blood samples were collected at baseline and 3, 6, and 12 months of follow-up, and 92 proteins (OLINK CV-III panel) were measured. The primary endpoint was the average mean PA pressure (mPAP) during the week preceding blood sample collection, in patients who received an invasive PA pressure sensor. Linear mixed models were used to evaluate the association between serial biomarker levels and mPAP, adjusting for sex and age, and correcting for multiple testing. This study included 165 patients who had a median age of 68 years (interquartile range, 61-75 years) and were predominantly male (78%). Fifteen biomarkers were significantly associated with the 7-day average mPAP, with 13 biomarkers maintaining consistent associations across different lag times. The strongest associations were found between mPAP and N-terminal pro-B-type natriuretic peptide, pulmonary surfactant protein D, insulin-like growth factor binding protein 7, and matrix metalloproteinase-2. CONCLUSIONS: We found a consistent association between invasive hemodynamic pressures and 13 serially measured blood biomarkers in chronic HF patients. These results could deepen the understanding and therapy guidance of congestive HF.