Physicians' Academy for Cardiovascular Education

Elevated pro-inflammatory biomarkers associated with decompensation in HFpEF

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Literature - Abernethy A, Raza S, Sun J-L, et al. - J Am Heart Assoc. 2018;7:e007385

Introduction and methods

Elevations in blood levels of pro-inflammatory biomarkers have been associated with severity and prognosis of heart failure with reduced ejection fraction (HFrEF), but it is not known whether this also true for heart failure with preserved ejection fraction (HFpEF) [1].

This post-hoc analysis of three studies assessed whether selected pro-inflammatory biomarkers are elevated in patients with acute decompensated (AD) HFpEF compared with patients with stable (S) HFpEF. Moreover it evaluated whether biomarker levels are associated with echocardiographic-Doppler abnormalities of left ventricular diastolic function, and whether they are predictive of clinical outcomes in AD-HFpEF patients. Clinical outcomes included urine volume, change in cystatin-C, change in creatinine, change in NT-proBNP, and change in weight over the 72 hours after randomization, as well as post-discharge survival and re-hospitalizations at 60 days.

For this purpose, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), high sensitivity C-reactive protein (hs-CRP) and pentraxin 3 (PTX3) levels were measured in age and sex-matched cohorts of HFpEF patients from 3 prospective, placebo-controlled, randomized clinical trials:

DOSE and ROSE included AD patients with HFrEF and HFpEF.

Main results


Levels of three pro-inflammatory biomarkers were significantly elevated in decompensated patients with HFpEF compared with stable HFpEF patients. These results suggest that chronic inflammation plays a role in the pathophysiology of HFpEF and that inflammatory marker levels increase during decompensation. This may provide a rationale for targeted anti-inflammatory therapy in HFpEF.


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