西南地区慢性心力衰竭患者合并低钠血症的临床特征△

目的了解西南地区慢性心力衰竭(chronic heart failure,CHF)患者与低钠血症的关系。方法入选2009年1月至2016年10月西南地区云南省、贵州省、四川省、重庆市12家医院住院的CHF患者,出院诊断为CHF、纽约心脏协会(NYHA)心功能分级处于II～IV级共3 359例进入研究,分析低钠血症与心功能、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)、脑钠肽(brain natriuretic peptide,BNP)、血尿酸(serum uric acid,SUA)、血清肌酐(serum creatinine,SCr)的关系。结果心功能Ⅳ级组患者血钠浓度明显低于心功能Ⅱ级与Ⅲ级组,差异有统计学意义(P0.01)。射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者低钠血症发病率高于射血分数中间值心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)、射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者,差异有统计学意义(P0.05)。与非低钠血症组相比,低钠血症组患者SCr、SUA、LVEDd、BNP增高,而LVEF降低,差异有统计学意义(P0.05)。回归方程分析提示血钠浓度与心功能、BNP、SUA呈负相关。结论低钠血症发生率与心功能有关,心功能越差,低钠血症发生率越高,HFrEF患者低钠血症发病率明显高于HFmrEF、HFpEF患者;血钠浓度与心功能、SCr、SUA、LVEDd、BNP呈负相关。     

射血分数正常心力衰竭与射血分数降低心力衰竭患者的临床基本特征比较——单中心资料

目的比较华南地区射血分数正常心力衰竭(heart failre with preserved ejection fraction,HFpEF)与射血分数降低心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者的临床特征及预后。方法收集2015年1月1日至2015年12月31日中山大学孙逸仙纪念医院心血管内科的心力衰竭患者资料329例,分为HFpEF组与HFrEF组,通过电话回访并进行回顾性分析。结果 329例心力衰竭患者中,HFpEF占64.1%。与HFrEF组比较,HFpEF组年龄更大、女性患者比例更多、收缩压更高、脉压差更大、吸烟史患者比例更低,差异有统计学意义(均P0.05);HFpEF组的N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proB-NP)、血红蛋白浓度均较低,合并有原发性高血压、贫血、心房颤动的患者比例均更高,差异有统计学意义(均P0.05);HFpEF组主动脉根部内径、左心室舒张末期内径均较小,室间隔厚度、相对室壁厚度均更大,差异有统计学意义(均P0.05)。随访结果显示,两组的全因病死率、心源性病死率、因心脏事件反复住院率比较,差异无统计学意义(P0.05)。结论 HFpEF和HFrEF在临床特征、发病机制上存在明显差异,但预后均较差。     

射血分数保留的心力衰竭研究现状

<正>心力衰竭是由于任何心脏结构或功能异常导致心室充盈或射血能力受损的一组复杂临床综合征,其主要临床表现为呼吸困难和乏力(活动耐量受限),以及液体潴留(肺淤血和外周水肿)。在我国,心力衰竭的患病率为0.9%,且患病率逐年增加。最近研究发现,超过50%的患者虽然有心力衰竭的症状体征,但其LVEF却是正常的~([1])。这种心力衰竭有别于射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFrEF),被称为射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)。     

老年射血分数中间值心力衰竭患者的临床特点分析

目的了解老年射血分数中间值的心力衰竭(HFmrEF)患者与射血分数减低的心力衰竭(HFrEF)及射血分数保留的心力衰竭(HFpEF)患者的病因、临床特点和治疗情况差异。方法入选2016年1月~2017年1月我院心力衰竭中心因心力衰竭住院的年龄≥60岁患者385例,按LVEF分为HFrEF组96例、HFmrEF组34例和HFpEF组255例。收集患者的人口学资料、心力衰竭病因、临床特点、心脏超声、检验结果和治疗情况,比较各组患者临床综合特征的差异。结果 HFmrEF组高血压比例最高(67.7%),瓣膜疾病比例次之(29.0%)。HFmrEF组住院期间静脉用硝酸酯类(44.1%vs 25.0%和16.5%)、出院肌酐[(131.66±55.7)μmol/L vs(80.49±33.97)μmol/L和(85.50±37.81)μmol/L]明显高于HFrEF组和HFpEF组;应用螺内酯和米力农的比例低于HFrEF组,而高于HFpEF组(P0.05,P0.01)。结论高血压、瓣膜疾病是老年HFmrEF的主要病因;且以男性和心功能Ⅳ级居多;此类患者出院肌酐水平偏高;同时,这部分老年心衰患者的转归尚可。     

高敏C反应蛋白对老年急性心肌梗死合并射血分数减低的心力衰竭患者预后的影响

目的 探讨入院时高敏C反应蛋白(high-sensitivity C-reactive protein, hs-CRP)水平对老年急性心肌梗死合并射血分数减低的心力衰竭(heart failure with reduced left ventricular ejection fraction, HFrEF)患者预后的影响。方法 连续入选2018年7月～2020年6月首都医科大学附属北京安贞医院心内科就诊的老年急性心肌梗死合并HFrEF患者152例,根据入院时hs-CRP水平分为hs-CRP增高组109例(hs-CRP>3 mg/L),hs-CRP正常组43例(hs-CRP≤3 mg/L)。患者随访374(99,822)d,观察住院和随访期间终点事件,其中一级终点为全因死亡,二级终点为心血管死亡和因心力衰竭再次住院率。结果 hs-CRP正常组应用β受体阻滞剂比例明显高于hs-CRP增高组(81.4%vs 64.2%,P=0.039)。hs-CRP增高组N末端B型钠尿肽前体水平明显高于hs-CRP正常组[(8792±4798)ng/L vs(6976±5237)ng/L,P=0.02...     

Galectin-3和sST2对射血分数保留的心力衰竭患者的诊断价值

目的:探索半乳糖凝集素-3(galectin-3)和可溶性基质溶素-2(sST2)对射血分数保留的心力衰竭(HFpEF)患者的诊断价值。方法:收集2015-12-2017-06收治于上海市第七人民医院心内科的215例HFpEF患者、108例射血分数降低的心力衰竭(HFrEF)患者和50名健康对照者的临床数据,并比较各组血清galectin-3和sST2水平。通过相关性分析和受试者工作特征(ROC)曲线下面积(AUC)明确galectin-3和sST2对HFpEF患者的诊断价值。结果:sST2、galectin-3和氨基末端B型利钠肽前体(NT-proBNP)水平随着射血分数的降低而显着升高。Galectin-3、sST2与NT-proBNP之间呈正相关。与对照组相比,HFpEF组在galectin-3的AUC为0.878,界值为8.47 ng/ml(灵敏度90.7%,特异性74%);NT-proBNP的AUC为0.926,sST2的AUC为0.664,其最佳界值分别为374.15 pg/ml和53.63 pg/ml。与HFrEF组对比,galectin-3、NT-proBNP和sST2的AUC分别为0.918、0.940和0.755。结论:Galectin-3和sST2是诊断HFpEF的潜在生物标志物。     

不同类型老年心力衰竭患者QRS波时限及心率变异性与心功能相关性

目的 探讨不同类型老年心力衰竭患者QRS波时限及心率变异性(HRV)与心功能相关性。方法 选取老年心力衰竭患者106例，男66例，女40例，根据左心室射血分数(LVEF)分为射血分数降低心力衰竭(HFrEF)组34例、射血分数中间值心力衰竭(HFmrEF)组33例、射血分数保留心力衰竭(HFpEF)组39例；完善脑钠肽(BNP)、心电图、动态心电图等相关检查。结果 HFrEF组QRS波时限长于HFmrEF组和HFpEF组，差异有统计学意义(P<0.01);HFmrEF组和HFpEF组无统计学差异(P>0.05);HFrEF组左室收缩末期内径(LVESD)明显大于HFmrEF组和HFpEF组(P<0.001),HFmrEF组明显大于HFpEF组(P<0.001);HFrEF组左室舒张末期内径(LVEDD)明显大于HFmrEF组和HFpEF组(P<0.001),HFmrEF组明显大于HFpEF组(P<0.001);3组间HRV时域指标无统计学差异(P>0.05)。相关性分析显示，老年心力衰竭患者QRS波时限与LVEF呈显著负相关性(r=-0.432...     

心力衰竭与心房颤动共存的流行病学和相关临床研究进展

心房颤动(atrial fibrillation,AF)和心力衰竭(heart failure,HF)经常共存,HF的两种亚型——射血分数保留型HF(HF with preserved ejection fraction,HFpEF)与射血分数降低型HF(HF with reduced ejection fraction,HFrEF)均在AF发生发展中起重要作用,互为因果,共同导致不良预后。从预防性研究看,许多研究集中于AF患者的卒中预防,但几乎没有研究关注在AF患者中HF的预测和预防。从治疗性研究看,药物治疗对AF与HF共存预后产生影响的证据非常有限,许多证据来自于观察性研究或者亚组分析的研究,或者有方法学缺陷的事后分析结果,需要谨慎解读。导管消融可降低HFrEF合并AF患者的死亡风险,然而对于HFpEF与AF并存的患者尚无研究证据。目前,亟需进行充分的头对头随机对照临床试验,以明确AF和HF之间复杂的相互关系,以期得到最佳预防与治疗措施。     

射血分数保留的心力衰竭影像学研究进展

<正>心力衰竭是严重威胁人类健康的高发病率和高致死率的疾病~([1-2])。2016年欧洲心脏学会制定的《急性和慢性心力衰竭诊断和治疗指南》将心力衰竭分为射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)、射血分数减低心力衰竭(heart failure with reduced ejection fraction,HFrEF)和中间发展期心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)~([3])。其中,HFmr EF是指LVEF介于40%～49%范围的左心功能减低,这一范围被视为心力衰竭发展的"灰色区域"(grey area)。而HFpEF是指由于长时间左心室充盈阻力增加导致的临床综合征,临床定义是LVEF≥50%的心力衰竭。HFpEF患者早期可无明显的临床     

HFpEF啮齿类动物模型的研究进展

心力衰竭(心衰)是各种心脏疾病的终末期状态, 多种机制参与其的发生发展。根据左心室射血分数, 可将心衰分为射血分数降低的心衰(HFrEF)、射血分数轻度降低的心衰(HFmrEF)和射血分数保留的心衰(HFpEF), 其中HFrEF和HFpEF占据了心衰患者的绝大多数。目前HFrEF的动物模型已较为成熟, 而HFpEF的动物模型则尚为缺乏, 这大大限制了有关HFpEF研究的开展。该文汇总了HFpEF啮齿类动物模型的建模方法和实验室检查指标, 并对各模型的优点与不足进行了阐述。     

射血分数中间值的心力衰竭患者的临床特征及预后研究

背景 射血分数中间值的心力衰竭(HFmrEF)作为心力衰竭新增分型,其病理生理机制、群体特征、合并症及临床特征与射血分数降低的心力衰竭(HFrEF)患者不尽相同.目的 探讨HFmrEF患者的临床特征及预后,以期为HFmrEF患者的临床诊治提供一定参考.方法 本研究为回顾性研究.选取2016年6月—2019年6月在石河子...     

托伐普坦对不同射血分数慢性心衰患者的临床疗效

目的:探究托伐普坦对不同射血分数慢性心衰(CHF)患者的临床疗效。方法:240例CHF患者根据左室射血分数(LVEF)不同分为射血分数下降组(HFrEF组,120例)和射血分数保留组(HFpEF组,120例),每组根据用药不同再分为常规治疗组(60例)和托伐普坦组(60例,常规治疗组基础上加用托伐普坦)。1个月后比较4组患者的临床疗效和用药安全性。结果:HFrEF组中,与治疗前比较,治疗后两亚组的LVEF、24h尿量、血钠水平均显著提高,左室舒张末期内径(LVEDd)、血肌酐(SCr)、血浆N末端脑钠肽前体(NT-proBNP)水平均显著降低(P均=0.001);且与常规治疗组比较,治疗后托伐普坦组的LVEF[(39.8±5.9)%比(46.7±6.5)%]、24h尿量[(2349.45±310.46)ml比(3104.34±401.35)ml]、血钠[(130.31±7.56)mmol/L比(138.20±8.03)mmol/L]水平及治疗的总有效率(83.3%比95.0%)均显著提高,LVEDd[(54.8±5.1)mm比(48.6±4.9)mm]、血浆NT-proBNP[(4169.47±1022.32)ng/ml比(3774.58±968.36)ng/ml]水平均显著降低,P<0.05或<0.01。HFpEF组中,与治疗前比较,治疗后两亚组的LVEF、24h尿量均显著提高,LVEDd、SCr和NT-proBNP水平均显著降低(P均=0.001);治疗后两组的各项指标无显著差异(P均>0.05)。结论:托伐普坦对不同LVEF的CHF患者均有疗效,可显著改善尿量、心功能,同时用药安全性好,而且对于HFrEF患者效果显著优于常规治疗,值得推广。     

肺部超声用于分析不同心力衰竭类型的比较及其与其他指标的相关性

目的 比较肺部超声在不同心衰(HF)类型中应用的差异,并分析肺部超声与其他指标的相关性。方法 124例急性HF患者,射血分数(EF)保留型HF组（HFpEF）48例;EF减低型HF组(HFrEF)76例。比较2组间临床资料以及心肺超声指标的差异,并进一步分析肺水B线在两种HF类型中分别与氨基末端脑钠尿肽原（NT-proBNP）、E/e’和左室EF（LVEF）的相关性的差异。结果 HFpEF组和HFrEF组两组患者在基本临床资料方面均无明显统计学差异; HFpEF组的LVEF、室间隔厚度明显高于HFrEF组,而左室舒张末期内径、左室收缩末期内径、下腔静脉直径均明显小于HFrEF组。两组患者的左房前后径、E/A、肺动脉压（PAP）、E/e’和B线均无明显统计学差异。在HFpEF组中B线与E/e’的相关性优于NT-proBNP（r=0.886,r=0.755）,而在 HFrEF组中肺水B线与NT-proBNP的相关性优于E/e’（r=0.829,r=0.737）。结论 无论HFpEF,还是HFrEF,B线与NT-proBNP、E/e’均有良好的正相关性。     

射血分数保留与射血分数降低的充血性心力衰竭患者左室结构和功能比较

目的 探讨射血分数保留充血性心力衰竭(HFpEF)与射血分数降低充血性心力衰竭(HFrEF)患者的左室结构和左室收缩功能的变化。方法 入选HFpEF及HFrEF患者各40例。入组者行超声心动图检查。经核素心血池显像测定分级小剂量多巴酚丁胺负荷后心率（HR）及左室收缩功能指标左室射血分数（LVEF）、高峰射血率（PER）、高峰射血时间（TPER）最大变化率。比较HFpEF及HFrEF患者6个月预后,观测HFpEF患者6个月后LVEF变化。结果 HFpEF组患者左房内径（LAD）、左室收缩期末内径（LVESD）、左室舒张期末内径（LVEDD）显著小于HFrEF组（均P<0.05）;HFpEF组患者室间隔厚度（IVST）、左室后壁厚度(LVPWT)大于HFrEF组（P<0.05）;HFpEF组LVEF在静息及各负荷值较HFrEF组高（P<0.05）,但LVEF最大变化率与HFrEF组比较无统计学意义。两组间PER最大变化率及TPER最大变化率比较无统计学意义。两组6个月内病死率无显著差异。HFpEF组6个月后存活患者有3例LVEF低于50%,发生率为9%。 结论 两组左房室结构存在明显差异,HFrEF组静息LVEF明显低于HFpEF组,但两组左室收缩功能储备基本一致,部分HFpEF患者可演变为HFrEF患者。     

Biomarkers in atrial fibrillation and heart failure with non-reduced ejection fraction: Diagnostic application and new cut-off points

BackgroundAtrial fibrillation (AF) and heart failure (HF) with non-reduced left ventricle ejection fraction (LVEF) present a diagnostic overlap. In this paper, we analyze differences in biomarkers between patients with and without HF, in a cohort of patients presenting with symptomatic AF. Differences in biomarkers between patients with medium range ejection fraction HF (HFmrEF) and those with preserved ejection fraction HF (HFpEF) are also analyzed.MethodsA total of 115 patients with symptomatic persistent AF were included. Seven biomarkers were measured: NT-proBNP, high sensitivity T troponin (hsTNT), galectin-3, ST2, fibrinogen, urate and C-reactive protein.ResultsPatients with non-reduced LVEF HF had significantly higher NT-proBNP levels than those without HF. This biomarker was the only variable independently related with the presence of non-reduced LVEF HF. Troponin was the only factor independently related with the presence of HFmrEF.ConclusionsNT-proBNP showed the best diagnostic accuracy for detecting the presence of non-reduced LVEF HF. We found higher diagnostic NT-proBNP cut-off values than those previously reported. Troponin was the most accurate biomarker differentiating HFmrEF from HFpEF.     

医联体背景下中老年射血分数中间值急性心力衰竭住院患者的临床特征及预后

目的:研究医联体背景下射血分数中间值的中老年急性失代偿心力衰竭(心衰)住院患者临床特征及1年内发生主要心血管事件的风险。方法:回顾性队列研究,连续收集天津市胸科医院心内科和天津河西医院诊区急性失代偿心衰住院患者180例,根据入院后左心室射血分数(LVEF)将心衰患者分为射血分数低(HFrEF,LVEF< 40%)组70...     

Epidemiologic Characterization of Heart Failure with Reduced or Preserved Ejection Fraction Populations Identified Using Medicare Claims

BackgroundAdministrative claims do not contain ejection fraction information for heart failure patients. We recently developed and validated a claims-based model to predict ejection fraction subtype.MethodsHeart failure patients aged 65 years or above from US Medicare fee-for-service claims were identified using diagnoses recorded after a 6-month baseline period of continuous enrollment, which was used to identify predictors and to apply the claims-based model to distinguish heart failure with reduced or preserved ejection fraction (HFrEF or HFpEF). Patients were followed for the composite outcome of time to first worsening heart failure event (heart failure hospitalization or outpatient intravenous diuretic treatment) or all-cause mortality.ResultsA total of 3,134,414 heart failure patients with an average age of 79 years were identified, of which 200,950 (6.4%) were classified as HFrEF. Among those classified as HFrEF, men comprised a larger proportion (68% vs 41%) and the average age was lower (76 vs 79 years) compared with HFpEF. History of myocardial infarction was more common in HFrEF (32% vs 13%), while hypertension was more common in HFpEF (71% vs 77%). One-year cumulative incidence of the composite endpoint was 42.6% for HFrEF and 36.9% for HFpEF. One-year all-cause mortality incidence was similar between the groups (27.4% for HFrEF and 26.4% for HFpEF), however, cardiovascular mortality was higher for HFrEF (15.6% vs 11.3%), whereas noncardiovascular mortality was higher for HFpEF (11.8% vs 15.1%).ConclusionWe replicated well-documented differences in key patient characteristics and cause-specific outcomes between HFrEF and HFpEF in populations identified based on the application of a claims-based model.     

Contribution of cardiac and extra‐cardiac disease burden to risk of cardiovascular outcomes varies by ejection fraction in heart failure

Aims

Patients with heart failure (HF) often have multiple co‐morbidities that contribute to the risk of adverse cardiovascular (CV) and non‐CV outcomes. We assessed the relative contribution of cardiac and extra‐cardiac disease burden and demographic factors to CV outcomes in HF patients with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF).

Methods and results

We utilized data from the CHARM trial, which enrolled HF patients across the ejection fraction spectrum. We decomposed the previously validated MAGGIC risk score into cardiac (LVEF, New York Heart Association class, systolic blood pressure, time since HF diagnosis, HF medication use), extra‐cardiac (body mass index, creatinine, diabetes mellitus, chronic obstructive pulmonary disease, smoker), and demographic (age, gender) categories, and calculated subscores for each patient representing the burden of each component. Cox proportional hazards models were used to estimate the population attributable risk (PAR) associated with each component to the outcomes of death, CV death, HF, myocardial infarction, and stroke relative to patients with the lowest risk score. PARs for each component were depicted across the spectrum of LVEF. in 2675 chronic HF patients from North America [HFrEF (LVEF ≤40%): n = 1589, HFpEF (LVEF >40%): n = 1086] with data available for calculation of the MAGGIC score, the highest risk of death and CV death was attributed to cardiac burden. This was especially evident in HFrEF patients (PAR: 76% cardiac disease vs. 58% extra‐cardiac disease, P < 0.05). Conversely, in HFpEF patients, extra‐cardiac burden accounted for a greater proportion of risk for death than cardiac burden (PAR: 15% cardiac disease vs. 49% extra‐cardiac disease, P < 0.05). For HF hospitalization, the contribution of both cardiac and extra‐cardiac burden was comparable in HFpEF patients (PAR: 42% cardiac disease vs. 53% extra‐cardiac disease, P = NS). In addition, demographic burden was especially high in HFpEF patients, with 62% of deaths attributable to demographic characteristics.

Conclusion

In North American HF patients enrolled in the CHARM trials, the relative contribution of cardiac and extra‐cardiac disease burden to CV outcomes and death differed depending on LVEF. The high risk of events attributable to non‐cardiac disease burden may help explain why cardiac disease‐modifying medication proven to be efficacious in HFrEF patients has not proven beneficial in HFpEF.

     

Sympathetic activation and outcomes in chronic heart failure: Does the neurohormonal hypothesis apply to mid-range and preserved ejection fraction patients?

BackgroundSympathetic activity (SA) is increased in patients with heart failure and reduced ejection fraction (HFrEF) and is associated with poor outcomes. However, its clinical implications are less understood in HF with mid-range (HFmrEF) and preserved ejection fraction (HFpEF). We aimed to study SA across left ventricle ejection fraction (LVEF) groups and its association with clinical outcomes.Methods and ResultsSA estimated by norepinephrine (NE) levels was determined in 742 consecutive outpatients with chronic HF: 348 (47%) with HFrEF, 116 (16%) HFmrEF, and 278 (37%) HFpEF. After a mean follow-up of 15 months, 17% died. Adjusted analyses showed that patients with HFpEF and HFmrEF had lower estimated marginal means of NE levels compared to HFrEF (278 and 116 pg/mL, respectively, vs. 348 pg/mL; p-value=0.005). Adjusted Cox regression analyses showed that high norepinephrine levels independently predicted all-cause mortality (ACM) in all 3 groups. The strongest associations between high NE levels and cardiovascular mortality (CVM) were observed in HFmrEF (HR: 4.7 [1.33–16.68]), while the weakest association was in HFpEF (HR: 2.62 [1.08–6.35]).ConclusionsAdjusted analyses showed that HFpEF and HFmrEF were associated with lower SA compared to HFrEF. Nevertheless, increasing NE levels were independently associated with ACM and CVM in all three LVEF groups. The strongest association between high NE levels and CVM was present in HFmrEF patients, while the weakest was seen in HFpEF. These findings could explain why the response to neurohormonal therapies in patients with HFmrEF is similar to that of patients with HFrEF rather than with HFpEF.     

Differences in biomarkers in patients with heart failure with a reduced vs a preserved left ventricular ejection fraction

Background

The differences in concentrations of biomarkers between heart failure (HF) patients with a preserved left ventricular ejection fraction (LVEF), or HF-PEF, and patients with HF with reduced LVEF (HF-REF) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and neurohormonal activation between these populations.

Methods

We performed a cross-sectional study of 29 subjects with symptomatic HF-REF (LVEF = 25.6 ± 5.1%) and 29 subjects with symptomatic HF-PEF (LVEF = 63.3 ± 5.3%). Concentrations of N-terminal proB-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hsCRP), procollagen type III amino-terminal peptide (PIIINP), matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of MMP (TIMP)-1 were measured.

Results

Although NT-proBNP and PIIINP concentrations were higher in patients with HF-REF compared with patients with HF-PEF (both P < 0.05), the only significant difference between the groups remaining after adjusting for possible confounding variables was NT-proBNP (P = 0.02). In patients with HF-REF, NT-proBNP correlated with PIIINP (P < 0.05), TIMP-1 (P < 0.05), and MMP-2 (P = 0.002), while PIIINP correlated with TIMP-1 (P < 0.05) and MMP-2 (P < 0.0001). In patients with a HF-PEF, only high sensitivity C-reactive protein correlated significantly with MMP-2 (P = 0.002).

Conclusions

Patients with HF-REF or HF-PEF presenting similar symptoms and functional limitations exhibit similar concentrations of biomarkers of ECM and inflammation. However, patients with HF-REF exhibit significantly higher NT-proBNP concentrations than patients with HF-PEF. The differences in the correlations observed between the biomarkers between these 2 populations suggest some heterogeneity and differences in the mechanisms related to the release or clearance of biomarkers in HF-REF vs HF-PEF.