Biomarker profile and short-term prognosis of “cardio-reno-metabolic phenotype” in chronic heart failure with preserved ejection fraction

Aim. To study the biomarker profile, clinical and echocardiographic characteristics of patients with the “cardio-reno-metabolic phenotype” of heart failure with preserved ejection fraction (HFpEF), as well as their impact on the six-month prognosis.
Material and methods. A prospective study of 80 patients with “cardio-reno-metabolic phenotype” of HFpEF was conducted. Anamnesis, clinical and demographic data, concomitant pathology were analyzed, enzyme immunoassay of blood serum was performed to determine the concentrations of the N-terminal fragment of brain natriuretic peptide (NT-proBNP), galectin-3, soluble form of tumor suppressor 2 (sST2), hypoxia-inducible factor 1-alpha (HIF-1α), carboxymethyllysine (CML), a six-minute walk test and echocardiographic examination with assessment of left ventricular diastolic function were performed.
Results. On average, the NT-proBNP level was 125.8 [109.4; 146.9] pg/ml, galectin-3 — 1.2 [0.9; 1.4] ng/ml, sST2 — 1.5 [0.4; 3.8] ng/ml, HIF-1α — 0.13±0.049 ng/ml, CML — 346.69±50.63 pg/ml. Within six months, 36.3% of patients were rehospitalized for any reason, 18.8% of them for cardiovascular diseases. A history of hospitalisation for a cardiovascular cause (decompensated CHF, uncontrolled hypertension, angina, rhythm disturbance) was an important risk factor for rehospitalisation during the six-month observation period. Using ROC analysis and binary logistic regression, clinical, laboratory, and instrumental predictors of early rehospitalisation for cardiovascular causes were identified: a history of such hospitalisation within the previous 6 months, left ventricular enddiastolic dimension greater than 5.05 cm, systolic pulmonary artery pressure greater than 24.5 mm Hg, H2FPEF score greater than 6.5 points, glomerular filtration rate less than 36.97 ml/min/1.73m², Charlson Comorbidity Index greater than 5.5 points, and galectin-3 level less than 1.5 ng/ml . Based on the data obtained, a model for predicting re-hospitalisation during 6 months of observation was developed, the sensitivity of which was 66.7%, specificity — 89.1%.
Conclusion. Predictors of early rehospitalisation for cardiovascular reasons for patients with the “cardio-reno-metabolic phenotype” of HFpEF include the history of hospitalisation for cardiovascular reasons in the previous 6 months, an increase in the left ventricular end-diastolic dimension, elevated systolic pulmonary artery pressure, decreasedglomerular filtration rate, Charlson comorbidity index, galectin-3 level, and the mean H2FPEF score.

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