Comparative Differences In Biomarkers In Patients With Heart Failure With Reduced Versus Preserved Ejection Fraction

Objective To compare the concentration of N-terminal proB-type natriuretic peptide (NT-pro BNP), high-sensitivity C-reactive protein (hs-CRP) and cystatin C (CysC) in patients with heart failure with reduced (HF-REF)versus preserved ejection fraction (HF-PEF), and to evaluate the relationship among these biomarkers in these two population.Methods106Out-patients with established diagnoses of heart failure were prospectively enrolled, including58HF-REF (Group A) and48HF-PEF patients (Group B). We determined NT-proBNP, CysC, hs-CRP, renal function, liver function, blood fat, and left ventricular ejection fraction (LVEF),and compared concentrations of these biomarkers. Their relationship also was evaluated. Fifty patients matched with age and gender, who were not heart failure patients, were enrolled as the controls.Results Patients with HF-REF had significantly higher concentrations of NT-proBNP and cystatin C (both P<0.05),but similar concentrations of hs CRP (P>0.05). After adjusting for possible confounding variables, only concentrations of NT-proBNP remained significantly higher in patients with HF-REF compared with patients with HF-PEF(P<0.01). In patients with HF-REF, NT-proBNP correlated with hs-CRP (r=0.482, P=0.009<0.05),cystatin C (r=0.450, P=0.014<0.05), while hs-CRP was not correlated with cystatin C (r=0.338, P=0.079>0.05). In patients with HF-PEF, NT-pro BNP only correlated significantly with cystatin C (r=0.429, P=0.041<0.05), while hs-CRP correlated with cystatin C (r=0.834, P<0.001)Conclusions:(1) Vasoactive peptide was compensatory increased in heart failure, the change of NT-proBNP is more obvious in HF-REF than HF-PEF.(2) Patients with HF-REF and HF-PEF presentsimilar concentrations of hsCRP and Cystatin C, these two biomarkers are unlikely to be useful to distinguish between HF-REF and HF-PEF.(3) The differences in the correlations between these biomarkers between these2populations suggest a potentially significant heterogeneity in the mechanisms involved in their release or clearance in HF-PEF compared with HF-REF, and need to be investigated further.