The Role of Biomarkers in Heart Failure with Preserved Ejection Fraction

Q: What is the clinical evidence from this study?

Study design: Review. Population: Heart Failure with Preserved Ejection Fraction (HFpEF). Intervention: Circulating biomarkers (including natriuretic peptides, high-sensitivity cardiac troponins, GDF-15, ST2, galectin-3, FABP4, cystatin C, microRNAs, metabolomics, and proteomics).

Q: What does this research mean for the field?

Natriuretic peptides remain the diagnostic gold standard for heart failure with preserved ejection fraction despite lower circulating concentrations than in heart failure with reduced ejection fraction, while a multimarker approach incorporating fibrotic, inflammatory, and metabolic biomarkers enhances prognostic assessment. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Humberto Villacorta; Alan S. Maisel

doi:10.36660/abchf.20220058

January 1, 2022ABC Heart Failure & CardiomyopathyOpen Access

The Role of Biomarkers in Heart Failure with Preserved Ejection Fraction

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Key Points

To examine the diagnostic utility, prognostic value, and biological mechanisms of cardiac and systemic circulating biomarkers in heart failure with preserved ejection fraction (HFpEF).
Reviewed clinical cohort and trial data evaluating natriuretic peptides, markers of systemic inflammation, and indicators of myocardial fibrosis.
Assessed biomarker performance in differentiating HFpEF from heart failure with reduced ejection fraction (HFrEF) and predicting clinical outcomes.
Mean concentrations of gold standard natriuretic peptides are lower in patients with HFpEF than in those with HFrEF, despite showing clinical utility across the ejection fraction spectrum.
GDF-15 differentiated HFpEF from healthy controls, and biomarker-based risk scores incorporating GDF-15 and troponin outperformed traditional clinical scores (ABC bleeding vs HAS-BLED, AUC 0.69 vs 0.62; ABC stroke vs CHADSVASC, AUC 0.67 vs 0.59).
Event-free survival decreased significantly in patients with HFpEF and FABP4 ≥ 43.5 ng/mL, while elevated soluble ST2 and Galectin-3 predicted severity and mortality.

Structured PICO

P

Population

Patients with heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%) and mildly reduced ejection fraction (HFmrEF, LVEF 40-49%)

I

Intervention

Circulating cardiac and systemic biomarkers (natriuretic peptides [BNP, NT-proBNP], high-sensitivity cardiac troponins [hs-cTn], GDF-15, sST2, galectin-3, inflammatory cytokines [TNF-alpha, IL-1, IL-6, IL-8, CRP], FABP4, cystatin C, circulating microRNAs, metabolomics, and proteomics)

O

Outcome

Diagnosis, risk stratification, prognosis, phenotyping, and therapy guidance in HFpEF

Limitations

Natriuretic peptide levels are influenced by comorbidities such as obesity (which lowers levels) and atrial fibrillation, older age, or renal dysfunction (which increase levels).
Systemic biomarkers are not specific to the heart and are therefore not useful for the primary diagnosis of HFpEF.
Novel biomarkers from microRNA, metabolomic, and proteomic analyses require further validation before translation into clinical practice.
Natriuretic peptide diagnostic performance in HFpEF is reduced compared to HFrEF, particularly in obese patients who exhibit lower concentrations.
Non-cardiac systemic biomarkers lack specificity for the heart and cannot be used for primary diagnosis.
Emerging biomarkers such as microRNAs, metabolomics, and proteomics require further clinical validation.

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Implication

This narrative review synthesizes the diagnostic and prognostic utility of established cardiac biomarkers (natriuretic peptides and troponins) alongside emerging systemic and multi-omic markers to improve phenotyping and risk stratification in HFpEF.

Abstract

are considered the gold standard biomarkers in HF and are secreted almost exclusively by the heart. Although the role of NP has been more extensively demonstrated in patients with reduced ejection fraction (HFrEF), their clinical value has been shown across the whole spectrum of ejection fraction. 10-12 However, the mean concentrations are lower in patients with HFpEF than in those with HFrEF. 13,14

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Cite This Study

Villacorta et al. (2022) conducted a review in Heart Failure with Preserved Ejection Fraction (HFpEF). Circulating biomarkers (including natriuretic peptides, high-sensitivity cardiac troponins, GDF-15, ST2, galectin-3, FABP4, cystatin C, microRNAs, metabolomics, and proteomics) was evaluated.

synapsesocial.com/papers/6a79ab7064a23396470223dd https://doi.org/10.36660/abchf.20220058

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The Role of Biomarkers in Heart Failure with Preserved Ejection Fraction

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Role of Biomarkers in Heart Failure with Preserved Ejection Fraction

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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