January 2018 at a Glance: Biomarkers, Co-Morbidities and Mechanical Circulatory Support

A position paper from the Heart Failure Association (HFA) reviews the prognostic significance of cardiopulmonary exercise testing in specific groups of patients with heart failure (HF), including the elderly, patients with obesity or other co-morbidities, preserved ejection fraction (HFpEF), permanent atrial fibrillation, those on mechanical circulatory support (MCS).1 Another HFA position paper reviews the prevalence, diagnosis, pathophysiology and possible treatments of right heart dysfunction in HFpEF.2 Lastly, Nagueh reviews parameters and methods for the non-invasive assessment of left ventricular end-diastolic pressure.3 Recent data have been published and the accuracy of non-invasive measurements is still a matter of analysis.4, 5 Three articles add data about the role of microRNAs as prognostic markers in HF.6, 7 Bayés-Genis et al.8 measured 12 microRNAs in two independent cohorts of HF patients. Circulating miR-1254 and miR-1306-5p were associated with outcomes but did not improve prognostic assessment over established prognostic variables. Masson et al.9 show that circulating miR-132 levels improve risk prediction for HF readmission beyond traditional factors but lack of additional predictive value for mortality. Lastly, serially measured, but not baseline, miR-1306-5p was predictive of poorer outcomes in patients with acute HF and had an additive value beyond natriuretic peptides.10 Lung function is tightly related with HF.11 Chronic obstructive pulmonary disease coexisted with HF in more than 15% of patients in the European Society of Cardiology HF Long-Term Registry. At multivariable analysis, it had a significant impact on treatment and HF hospitalization rates but not on mortality.12 These results confirm previous data.13-15 Tkaczyszyn et al.16 have related iron deficiency (ID) with serum haemoglobin levels and red cell indices in 1821 patients with HF. Iron deficiency was common, ranging from 75% in patients with anaemia and abnormal red cell indices to 36% in non-anaemic patients with normal indices. Patients with ID tended to have higher mortality. Anker et al.17 investigated the effects of ferric carboxymaltose on recurrent hospitalizations and mortality in an individual patient data meta-analysis of four placebo-controlled trials in HF with reduced ejection fraction patients with ID. Administration of ferric carboxymaltose was associated with lower rates of recurrent cardiovascular or HF hospitalizations, adding further data to previous meta-analyses not based on individual data.18 Diabetes coexists in a high proportion of patients with HF and has a major impact on their treatment and outcomes.14, 19, 20 Kristensen et al.21 analyse the outcomes of patients with diabetes, compared with non-diabetics, in the Aliskiren Trial of Minimizing OutcomeS for Patients with HEart failuRE (ATMOSPHERE) trial. Different from other studies, no signal of harm and a trend towards benefit with aliskiren monotherapy vs. enalapril was noted, whereas combined aliskiren and enalapril treatment led to more adverse events and no improvement in outcomes.21 Catino et al.22 show that concomitant administration of HF treatment with neurohormonal antagonists is associated with a larger improvement in cardiac function and less fibrosis in HF patients on MCS. Barge-Caballero et al.23 show that temporary MCS can be used in critically ill candidates as a direct bridge to heart transplantation in a setting with short waiting times, such as in Spain.