Key result
Elevated serum FABP4 levels (≥43.5 ng/mL) in patients with HFpEF were associated with significantly decreased event-free survival for all-cause mortality or HF hospitalization (P=0.003).
Why the study?
Systemic metabolic impairment is central to HFpEF pathophysiology, leading authors to hypothesize that circulating FABP4 levels are elevated, correlate with cardiac abnormalities, and predict clinical outcomes.
Do elevated serum FABP4 levels predict all-cause mortality or HF hospitalization in Asian patients with HFpEF?
Cohort (n=112)
Do elevated serum FABP4 levels predict all-cause mortality or HF hospitalization in Asian patients with HFpEF?
p-value: p=0.003
Elevated serum FABP4 levels are associated with cardiac remodeling, dysfunction, and worse clinical outcomes in Asian patients with HFpEF, suggesting its potential as a biomarker.
Supports FABP4 as potential prognostic marker in HFpEF; hypothesis-generating and should not change practice without validation.
AIMS: Systemic metabolic impairment is the key pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). Fatty acid-binding protein 4 (FABP4) is highly expressed in adipocytes and secreted in response to lipolytic signals. We hypothesized that circulating FABP4 levels would be elevated in patients with HFpEF, would correlate with cardiac structural and functional abnormalities, and could predict clinical outcomes. METHODS AND RESULTS: Serum FABP4 measurements and echocardiography were performed in patients with HFpEF (n = 92) and those with coronary artery disease free of HF (n = 20). Patients were prospectively followed-up for a composite endpoint of all-cause mortality or HF hospitalization. Compared with patients with coronary artery disease, those with HFpEF had higher FABP4 levels [12.5 (9.1-21.0) vs. 43.5 (24.6-77.4) ng/mL, P < 0.0001]. FABP4 levels were associated with cardiac remodelling (left ventricular mass index: r = 0.29, P = 0.002; left atrial volume index: r = 0.40, P < 0.0001), left ventricular systolic and diastolic dysfunction (global longitudinal strain: r = -0.24, P = 0.01; E/e' ratio: r = 0.29, P = 0.002; and N-terminal pro-B-type natriuretic peptide: r = 0.62, P < 0.0001), and right ventricular dysfunction (tricuspid annular plane systolic excursion: r = -0.43, P < 0.0001). During a median follow-up of 9.1 months, there were 28 primary endpoints in the HFpEF cohort. Event-free survival was significantly decreased in patients with FABP4 levels ≥43.5 ng/mL than in those with FABP4 levels <43.5 ng/mL (P = 0.003). CONCLUSIONS: Serum FABP4 levels were increased in HFpEF and were associated with cardiac remodelling and dysfunction, and poor outcomes. Thus, FABP4 could be a potential biomarker in the complex pathophysiology of HFpEF.
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Harada et al. (2020) conducted a cohort in Heart failure with preserved ejection fraction (n=112). Serum FABP4 levels vs. FABP4 levels <43.5 ng/mL was evaluated on Composite of all-cause mortality or HF hospitalization (p=0.003). Elevated serum FABP4 levels (≥43.5 ng/mL) in patients with HFpEF were associated with significantly decreased event-free survival for all-cause mortality or HF hospitalization (P=0.003).
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