Pathophysiologic Processes and Novel Biomarkers Associated With Congestion in Heart Failure

Pandhi, Paloma; Maaten, Jozine M. ter; Anker, Stefan D.; Ng, Leong L.; Metra, Marco; Samani, Nilesh J.; Lang, Chim C.; Dickstein, Kenneth; Boer, Rudolf A. de; Veldhuisen, Dirk J. van; Voors, Adriaan A.; Sama, Iziah E.

doi:10.1016/j.jchf.2022.05.013

Cited by 27 publications

(10 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previously, plasmatic FGF-23 was also identi ed as one of the proteins most strongly associated with congestion. 23 We have con rmed and further extended these ndings; besides its association with congestion, FGF-23 is related to RV dysfunction regardless of congestion status.…”

Section: Discussionsupporting

confidence: 71%

FGF-23 is a Biomarker of RV Dysfunction and Congestion in Patients with HFrEF

Beneš

Kroupova

Kotrč

et al. 2023

Preprint

View full text Add to dashboard Cite

Aims: There is no biomarker reflecting right ventricular dysfunction in HFrEF patients used in clinical practice. We have aimed to look for a circulating marker of RV dysfunction employing a quantitative proteomic strategy. Methods and Results: The Olink Proteomics Multiplex panels (Cardiovascular Disease II, III, Cardiometabolic, and Inflammation Target Panels) identified FGF-23 to be the most differentially abundant (more than 2.5-fold) in blood plasma of HF patients with severe RV dysfunction (n=30) compared to those with preserved RV function (n= 31). A subsequent ELISA-based confirmatory analysis of circulating FGF-23 in a large cohort of patients (n= 344, 72.7% NYHA III/IV, LVEF 22.5%, 54.1% with moderate/severe RV dysfunction), followed by multivariable regression analysis, revealed that the plasma FGF-23 level was most significantly associated with RV dysfunction grade (p= 0.0004) and congestion in the systemic circulation (p= 0.03), but not with LV-ejection fraction (p= 0.69) or estimated glomerular filtration rate (eGFR, p= 0.08). FGF-23 was associated with the degree of RV dysfunction in both sub-cohorts (i.e. in patients with and without congestion, p<0.0001). The association between FGF-23 and RV-dysfunction remained significant after the adjustment for BNP (p= 0.01). In contrast, when adjusted for BNP, FGF-23 was no longer associated with LV dysfunction (p=0.59). The Cox proportional hazard model revealed that circulating FGF-23 was significantly associated with adverse outcomes even after adjusting for BNP, LVEF, RV dysfunction grade and eGFR. Conclusion: Circulating FGF-23 is a biomarker of right ventricular dysfunction in HFrEF patients regardless of congestion status.

show abstract

Section: Discussionsupporting

confidence: 71%

FGF-23 is a Biomarker of RV Dysfunction and Congestion in Patients with HFrEF

Beneš

Kroupova

Kotrč

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…( 9 ) reported that the combined opposite effects of a hypometabolic state brought on by hypothyroidism and increased production of proinflammatory cytokines and endothelins may explain the neutral effect of OHypo on NT-proBNP. Endothelins and proinflammatory cytokines are known to initiate the release of NT-proBNP ( 53 ), and there is some proof that thyroid autoimmunity and OHypo cause an inflammatory state and endothelial dysfunction ( 54 – 56 ). However, the underlying cardiac condition may affect the manifestation of TD.…”

Section: Discussionmentioning

confidence: 99%

Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis

Zhang

et al. 2023

Front. Endocrinol.

View full text Add to dashboard Cite

PurposeThyroid hormones (THs) significantly affect the cardiovascular system. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful biomarker for diagnosing, evaluating, and predicting outcomes in heart failure (HF). This comprehensive review and meta-analysis aimed to investigate the effects of thyroid dysfunction (hypothyroidism and hyperthyroidism) on NT-proBNP levels.MethodsTwo investigators independently searched PubMed, Embase, Cochrane Library, and Web of Science databases for studies published from inception to July 31, 2022, without any restrictions on language.Results21 studies were included. In participants without HF, NT-proBNP levels may be elevated in those with overt hyperthyroidism (standardized mean difference [SMD] 2.38, 95% confidence interval [CI]:1.0-3.76). Notably, among patients with preexisting HF, significantly higher NT-proBNP levels were found in patients with overt hyperthyroidism, overt hypothyroidism, or subclinical hypothyroidism than in euthyroid subjects (SMD [95%CI] = 0.31[0.01, 0.62], 0.32[0.08, 0.56], and 0.33[0.21, 0.46], respectively). Seven trials compared NT-proBNP levels in patients with thyroid dysfunction before and after therapy, and significant drops in NT-proBNP levels were observed in patients with hyperthyroidism (SMD [95%CI] = -1.53[-2.50, -0.55]) upon achieving a euthyroid state. In contrast, increased NT-proBNP levels were observed in hypothyroid patients after treatment (SMD [95%CI] = 1.07[0.28, 1.85]).ConclusionThyroid dysfunction can significantly affect NT-proBNP levels, which may change upon achieving a euthyroid state. Notably, the effect of thyroid dysfunction on cardiac function may depend on the underlying cardiac status. Thus, timely recognition and effective treatment of cardiac symptoms in patients with thyroid dysfunction are mandatory because the prognosis of HF may be improved with appropriate treatment of thyroid dysfunction.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42022353700.

show abstract

“…20 Pathophysiological mechanisms underlying development of congestion in HF (both heamodynamic and clinical) are complex, multifactorial and beyond the scope of this paper. [21][22][23][24][25] Below, we briefly present selected mechanisms relevant for the discussion.…”

Section: Congestion -The Hallmark Of Heart Failurementioning

confidence: 99%

“…Elevated cardiac filling pressures can be detected in patients with HF but without (or only with minimal) overt signs/symptoms of congestion, which is termed ‘haemodynamic congestion’ and often precedes symptom/sign development 20 . Pathophysiological mechanisms underlying development of congestion in HF (both heamodynamic and clinical) are complex, multifactorial and beyond the scope of this paper 21–25 . Below, we briefly present selected mechanisms relevant for the discussion.…”

Section: Congestion – the Hallmark Of Heart Failurementioning

confidence: 99%

Sodium–glucose cotransporter‐2 inhibitors in heart failure: Potential decongestive mechanisms and current clinical studies

Biegus

Fudim

Salah

et al. 2023

European J of Heart Fail

Self Cite

View full text Add to dashboard Cite

Congestion is a key pathophysiological feature of heart failure (HF) syndrome that drives most of the clinical manifestations of acute HF and is related with poor quality of life and outcomes. Therefore, safe and effective decongestion is an important therapeutic target in the management of acute HF and despite the use of guideline‐recommended loop diuretics, adequate decongestion is not always achieved in patients with acute HF. Recently, sodium–glucose cotransporter‐2 (SGLT‐2) inhibitors have been shown to provide clinical benefits across a broad spectrum of patients with HF, including consistent reduction in the risk of acute HF episodes. While the exact mechanisms underlying these benefits remain a matter of debate, a growing body of evidence suggests that effective decongestion may be partly responsible, especially in the setting of acute HF. In this review, we discuss the potential decongestive mechanisms of SGLT‐2 inhibitors, such as osmotic diuresis, natriuresis, preservation of glomerular filtration and facilitation of interstitial drainage, which can collectively translate into effective and safe decongestion. Furthermore, we provide a comprehensive review of up‐to‐date clinical data of SGLT‐2 inhibitor use in the acute HF population.

show abstract

Pathophysiologic Processes and Novel Biomarkers Associated With Congestion in Heart Failure

Cited by 27 publications

References 36 publications

FGF-23 is a Biomarker of RV Dysfunction and Congestion in Patients with HFrEF

FGF-23 is a Biomarker of RV Dysfunction and Congestion in Patients with HFrEF

Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis

Sodium–glucose cotransporter‐2 inhibitors in heart failure: Potential decongestive mechanisms and current clinical studies

Contact Info

Product

Resources

About