Abstract • Background Severe heart failure with reduced ejection fraction (HFrEF) affects millions of people but its burden is still growing. The often sudden, negative progression of HFrEF leads either to left ventricular assist device (LVAD) implant or to heart transplantation, to avoid death. Implementation of prognostic tools remains a challenge. • Purpose This study aims at investigating the P2X purinoceptor 7 (P2X7) and two miRs targeting P2X7 protein, namely miR-150-5p and miR-186-5p, in platelet-rich-plasma (PRP) and platelet-poor-plasma (PPP), comparing patients with HFrEF responding to therapy and patients scheduled for LVAD implant, • Methods Twenty patients with HFrEF, 20 implanting LVAD and 11 healthy individuals (controls) were enrolled. Clinical data from patients were collected. Blood samples (5ml) were collected in EDTA tubes at monitoring visit or at hospitalization for implant, respectively, and PRP separated from PPP. Total RNA and proteins were extracted. Quantitative real-time PCR and ELISA assays, and basic statistics were used. • Results P2X7 gene in PPP and miR-186-5p in both PPP and PRP were different in HFrEF group vs. controls, P2X7 gene in PRP and protein in PPP between patient’ groups, i.e., HFrEF vs. LVAD. The miR-186-5p in PPP was associated to right ventricular dysfunction in the HFrEF group, the miR-150-5p and P2X7 in PRP to mitral regurgitation degree, in LVAD group. Differences in smoking history and drug assumption (namely antiplatelet drugs, ACE inhibitors, aldosterone antagonists, beta-blockers, Angiotensin II receptor blockers) correlated with miR-186-5p expression in the HFrEF group, suggesting a relationship with risk factors and therapy. The occurrence of cardiogenic shock and the temporary implant of mechanical circulatory supports were associated with differences in miR-150-5p in PPP in the LVAD group. • Conclusions Overall, P2X7 and miR-186-5p emerge as promising candidate biomarkers differentiating LVAD from HFrEF. The miR-150-5p might play a role in the patient response to mechanical supports. These findings pave the way to further large-scale studies aimed at: validating the prognostic power of P2X7 and miR-186-5p in HFrEF, establish the mechanistic involvement of miR-186-5p in drug responsivity and the value of miR-150-5p in relation to patient responsivity to mechanical circulatory supports.
Spartano et al. (Fri,) studied this question.