Heart Failure with Preserved Ejection Fraction in the Elderly: Conventional and Emerging Prognostic Biomarkers in Daily Clinical Practice

Aim: Albumin serum levels and N-terminal pro-brain natriuretic peptide (NT proBNP) have shown to be useful in predicting outcome in patients with heart failure (HF) and systolic dysfunction.Carbohydrate antigen 125 (CA 125) has also been associated to a higher risk of mortality and rehospitalization in patients with HF and impaired left ventricular systolic function.The aim of this study was to evaluate the prognostic role of these biomarkers among acute decompensated HF with preserved ejection fraction (HFpEF) elderly patients.Methods and results: Data were collected prospectively from 154 consecutive patients with HFpEF admitted to our institution between 2011 and 2012.They were followed for one year after hospital discharge.Average age was 81 years (SD 9) and 63% were female.During follow-up, 37 patients died (mortality rate: 24%).In the multivariable analysis, NT proBNP > 2086 ng/l was identified as an independent predictor of mortality (OR 5.36; 1.84-15.65,CI 95%, p = 0.002).In the same way, hypoalbuminaemia (RR 2.57; 1.46-4.52,CI 95%, p = 0.001) and CA 125 plasmatic concentrations > 31 U/ml (RR 2.58; 1.23-5.43,CI 95%, p = 0.008) also were related to a higher risk of death in the univariable analysis.Finally, we found that the combination of NT proBNP plasmatic concentrations > 2086 ng/l, albuminaemia < 3.5 g/dl and CA 125 > 31 U/ml was associated to a worse outcome among acute decompensated HFpEF patients (RR 3.32; 1.91-5.78,CI 95%, p < 0.0001).Conclusion: NT proBNP, albuminaemia, and CA 125 could be used as filtering tools to select those with the highest clinical risk among hospitalized HFpEF patients.