Structured Abstract
Objectives
To investigate relationships between insulin-like growth factor-binding protein 7 (IGFBP7) and parameters of diastolic function or functional capacity in patients with heart failure and preserved ejection fraction (HFpEF), randomized to receive sildenafil or placebo.
Background
IGFBP7 was previously found to be associated with diastolic function in HF with reduced EF, but it is unclear whether these associations are present in HFpEF.
Methods
At baseline and 24 weeks, IGFBP7, imaging studies, and peak oxygen consumption (VO2max) were obtained and compared in 160 HFpEF patients randomized to receive sildenafil or placebo.
Results
Patients with supramedian baseline IGFBP7 concentrations were older, had signs of systemic congestion and worse renal function, and had higher concentrations of prognostic HF biomarkers including amino-terminal pro-B-type natriuretic peptide (P<0.05). Higher baseline IGFBP7 was modestly correlated with worse diastolic function: higher E velocity (ρ=0.40), E/E’ (ρ=0.40), left atrial volume index (ρ=0.39), and estimated right ventricular systolic pressure (RVSP; ρ=0.41; all P<0.001) and weakly correlated with transmitral E/A (ρ=0.26, P=0.006). Notably, change (Δ) in IGFBP7 was significantly correlated with change in E, E/A, E/E’, and RVSP. Elevated baseline IGFBP7 was associated with lower baseline VO2max (13.2 versus 11.1 mL/min/kg; P<0.001) and ΔIGFBP7 was weakly inversely correlated with ΔVO2max (ρ=−0.19, P=0.01). Subjects receiving sildenafil had a decrease in IGFBP7 over 24 weeks, in contrast to placebo-treated patients (median ΔIGFBP7 −1.5 versus +13.6 ng/mL; P<0.001).
Conclusions
In patients with HFpEF, IGFBP7 may be a novel biomarker of diastolic function and exercise capacity.