Jasper Tromp1, Mohsin A F Khan2, Robert J Mentz3, Christopher M O'Connor4, Marco Metra5, Howard C Dittrich6, Piotr Ponikowski7, John R Teerlink8, Gad Cotter9, Beth Davison9, John G F Cleland10, Michael M Givertz11, Daniel M Bloomfield12, Dirk J Van Veldhuisen1, Hans L Hillege13, Adriaan A Voors14, Peter van der Meer1. 1. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 2. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Heart Failure Research Centre, Academic Medical Centre, Amsterdam, the Netherlands. 3. Duke University Medical Center, Durham, North Carolina. 4. Inova Heart and Vascular Institute, Falls Church, Virginia. 5. University of Brescia, Brescia, Italy. 6. Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa. 7. Medical University, Clinical Military Hospital, Wroclaw, Poland. 8. University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California. 9. Momentum Research, Durham, North Carolina. 10. University of Hull, Kingston upon Hull, United Kingdom. 11. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 12. Merck & Co., Inc., Kenilworth, New Jersey. 13. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 14. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: a.a.voors@umcg.nl.
Abstract
OBJECTIVES: In this study, the authors used biomarker profiles to characterize differences between patients with acute heart failure with a midrange ejection fraction (HFmrEF) and compare them with patients with a reduced (heart failure with a reduced ejection fraction [HFrEF]) and preserved (heart failure with a preserved ejection fraction [HFpEF]) ejection fraction. BACKGROUND: Limited data are available on biomarker profiles in acute HFmrEF. METHODS: A panel of 37 biomarkers from different pathophysiological domains (e.g., myocardial stretch, inflammation, angiogenesis, oxidative stress, hematopoiesis) were measured at admission and after 24 h in 843 acute heart failure patients from the PROTECT trial. HFpEF was defined as left ventricular ejection fraction (LVEF) of ≥50% (n = 108), HFrEF as LVEF of <40% (n = 607), and HFmrEF as LVEF of 40% to 49% (n = 128). RESULTS:Hemoglobin and brain natriuretic peptide levels (300 pg/ml [HFpEF]; 397 pg/ml [HFmrEF]; 521 pg/ml [HFrEF]; ptrend <0.001) showed an upward trend with decreasing LVEF. Network analysis showed that in HFrEF interactions between biomarkers were mostly related to cardiac stretch, whereas in HFpEF, biomarker interactions were mostly related to inflammation. In HFmrEF, biomarker interactions were both related to inflammation and cardiac stretch. In HFpEF and HFmrEF (but not in HFrEF), remodeling markers at admission and changes in levels of inflammatory markers across the first 24 h were predictive for all-cause mortality and rehospitalization at 60 days (pinteraction <0.05). CONCLUSIONS: Biomarker profiles in patients with acute HFrEF were mainly related to cardiac stretch and in HFpEF related to inflammation. Patients with HFmrEF showed an intermediate biomarker profile with biomarker interactions between both cardiac stretch and inflammation markers. (PROTECT-1: A Study of the Selective A1 Adenosine Receptor Antagonist KW-3902 for Patients Hospitalized With Acute HF and Volume Overload to Assess Treatment Effect on Congestion and Renal Function; NCT00328692).
RCT Entities:
OBJECTIVES: In this study, the authors used biomarker profiles to characterize differences between patients with acute heart failure with a midrange ejection fraction (HFmrEF) and compare them with patients with a reduced (heart failure with a reduced ejection fraction [HFrEF]) and preserved (heart failure with a preserved ejection fraction [HFpEF]) ejection fraction. BACKGROUND: Limited data are available on biomarker profiles in acute HFmrEF. METHODS: A panel of 37 biomarkers from different pathophysiological domains (e.g., myocardial stretch, inflammation, angiogenesis, oxidative stress, hematopoiesis) were measured at admission and after 24 h in 843 acute heart failurepatients from the PROTECT trial. HFpEF was defined as left ventricular ejection fraction (LVEF) of ≥50% (n = 108), HFrEF as LVEF of <40% (n = 607), and HFmrEF as LVEF of 40% to 49% (n = 128). RESULTS: Hemoglobin and brain natriuretic peptide levels (300 pg/ml [HFpEF]; 397 pg/ml [HFmrEF]; 521 pg/ml [HFrEF]; ptrend <0.001) showed an upward trend with decreasing LVEF. Network analysis showed that in HFrEF interactions between biomarkers were mostly related to cardiac stretch, whereas in HFpEF, biomarker interactions were mostly related to inflammation. In HFmrEF, biomarker interactions were both related to inflammation and cardiac stretch. In HFpEF and HFmrEF (but not in HFrEF), remodeling markers at admission and changes in levels of inflammatory markers across the first 24 h were predictive for all-cause mortality and rehospitalization at 60 days (pinteraction <0.05). CONCLUSIONS: Biomarker profiles in patients with acute HFrEF were mainly related to cardiac stretch and in HFpEF related to inflammation. Patients with HFmrEF showed an intermediate biomarker profile with biomarker interactions between both cardiac stretch and inflammation markers. (PROTECT-1: A Study of the Selective A1 Adenosine Receptor Antagonist KW-3902 for Patients Hospitalized With Acute HF and Volume Overload to Assess Treatment Effect on Congestion and Renal Function; NCT00328692).
Authors: Luigi Adamo; Jinsheng Yu; Cibele Rocha-Resende; Ali Javaheri; Richard D Head; Douglas L Mann Journal: J Am Coll Cardiol Date: 2020-10-27 Impact factor: 24.094
Authors: Julio A Chirinos; Alena Orlenko; Lei Zhao; Michael D Basso; Mary Ellen Cvijic; Zhuyin Li; Thomas E Spires; Melissa Yarde; Zhaoqing Wang; Dietmar A Seiffert; Stuart Prenner; Payman Zamani; Priyanka Bhattacharya; Anupam Kumar; Kenneth B Margulies; Bruce D Car; David A Gordon; Jason H Moore; Thomas P Cappola Journal: J Am Coll Cardiol Date: 2020-03-24 Impact factor: 24.094