Distinct Plasma Extracellular Vesicle Transcriptomes in Acute Decompensated Heart Failure Subtypes: A Liquid Biopsy Approach

Heart failure (HF) is a multifactorial disease that poses significant challenges to clinical management.Most efforts to define the molecular architecture of HF have focused on the myocardium, 1 with the aim of identifying potential pathways of recovery and therapeutic interventions.This approach has fueled the debate over the relative contributions of noncardiac factors (such as muscle, vascular, and metabolic) versus cardiac factors to HF, specifically in HF with preserved ejection fraction (HFpEF).Despite literature implicating metabolic dysfunction across multiple systems in HFpEF, circulating "omic" markers (e.g., genomics, proteins) do not effectively discriminate between the HF subtypes (HFpEF vs. HF with reduced ejection fraction, HFrEF).This underscores the need for more phenotype-specific markers to assess HF status and multi-organ function.