Phenotypic clusters and biomarkers profile in patients with chronic heart failure with preserved and mildly reduced left ventricular ejection fraction

Aim. To study the profile of cardiac biomarkers (NT-proBNP – N-terminal pro-brain natriuretic peptide, sST2 – soluble growth stimulation expressed gene 2, galectin-3, copeptin) in clusters of patients with chronic heart failure with preserved (CHFpEF) and mildly reduced (CHFmrEF) left ventricular (LV) ejection fraction (EF).

Materials and methods. The study included 135 patients with CHF and LV EF>40%. All patients signed informed consent.

Results. Patients in the study were of senior age – 76 [65; 82] years; 56% are women. The most common comorbid diseases were hypertension and ischemic heart disease, including previous AMI, CKD, obesity and AF. During the cluster analysis, 4 clusters were identified: 1 – “ischemic”, in which men aged 64 [57.5; 76.3] years old with coronary artery disease and previous myocardial infarction and COPD. 2 – “hypertensive”, represented by elderly women 80.0 [74.3; 85.5] years old with arterial hypertension. 3 – “maladaptive with multiple organ disorders” – represented by elderly women with AF, signs of pulmonary hypertension, lower LV EF (48 [43; 54]%) and CKD. 4 – “cardiometabolic” – included female patients aged 71 [60.0; 78.0] years old, with obesity and type 2 diabetes, CKD and AF. In patients of cluster 3 there were higher concentrations of NT-proBNP (1640 [746; 2218] pg/ml; p=0.0015), sST2 (25.2 [17.0; 54.5] ng/ml) and galectin-3 – 11.8 [9.5; 14.3] ng/ml and the highest one-year mortality rate – 33.3%.

Conclusion. Four distinct clusters of CHF with LV EF>40% patients were identified that differed in clinical characteristics, heart failure biomarkers and prognosis: ischemic, hypertensive, cardiometabolic and maladaptive with multiple organ dysfunction. These results confirm the heterogeneity of CHFpEF and CHFmrEF and create the prerequisites for the development of personalized approaches to therapy.