Biomarkers for the diagnosis and management of heart failure

Association between dietary fiber intake and all-cause and CVD-caused mortality among heart failure survivors: a cohort study from the NHANES database

Aim

Heart failure (HF) is a severe manifestation or late stage of various heart diseases. As an anti-inflammatory nutrient, dietary fiber has been shown to be associated with the progression and prognosis of cardiovascular diseases (CVDs). However, little is known about the relationship between dietary fiber intake and mortality in HF survivors. This study evaluated the association between dietary fiber intake and all-cause and CVD-caused mortality among HF survivors.

Methods

Data for the study were extracted from the National Health and Nutrition Examination Survey 1999-2018. Dietary fiber intake information was obtained by a 24-h dietary recall interview. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Covariates, including sociodemographic, lifestyle, disease history, and laboratory data, were extracted from the database. The weighted univariate and multivariate Cox proportional hazard models were utilized to explore the association between dietary fiber intake and mortality among HF survivors, with hazard ratios and 95% confidence intervals. Further stratified analyses were performed to explore this association based on age, gender, a history of diabetes and dyslipidemia, and duration of HF.

Results

A total of 1,510 patients were included. Up to 31 December 2019, 859 deaths had occurred over a mean follow-up of 70.00 months. After multivariable adjustment, a higher dietary fiber intake was associated with a lower risk of all-cause and CVD-caused mortality in HF survivors, especially in male patients, those aged <60 years old, and those with a history of diabetes and dyslipidemia.

Conclusion

Among HF survivors, higher dietary fiber intake levels may be associated with a good health outcome. More large-scale prospective cohort studies are needed to further explore this benefit relationship.

Broad antifibrotic activities of AK3280 in pulmonary, hepatic, cardiac, and skin fibrosis animal models

Fibrosis is the pathological outcome of many chronic inflammatory diseases, affecting various human organs. It is a significant contributor to global morbidity and mortality that affects nearly half of the elderly population. Pirfenidone (PFD) and nintedanib are approved by the FDA for treating pulmonary fibrosis, but these treatments are associated with poor tolerability and limited efficacy. Moreover, no antifibrotic drugs are approved for other fibrosis-related diseases, highlighting an urgent unmet medical need for more effective therapies. Here we report the in vivo pharmacological activities of AK3280, a novel, orally bioavailable small molecule designed to enhance pharmacokinetics, antifibrotic activity, and tolerability over PFD. AK3280 demonstrated antifibrotic effects across multiple organs, including the lungs, liver, heart, and skin, in various animal models. These results suggest that AK3280 holds promise as a clinically beneficial antifibrotic therapy for a range of fibrotic diseases, especially pulmonary, hepatic, cardiac, and skin fibrosis.

Association of microRNA-210-3p with NT-proBNP, sST2, and Galectin-3 in heart failure patients with preserved and reduced ejection fraction: A cross-sectional study

BACKGROUND

Heart failure (HF) is a growing health problem and around two percent are affected in the general population. Accurate diagnostic markers that have the potential for early diagnosis of HF are lacking. This study aimed to compare the expression levels of microRNA-210-3p with biomarkers NT-proBNP, sST2, and galectin-3, in heart failure patients with preserved and reduced ejection fractions.

MATERIALS AND METHODS

The cross-sectional study was conducted on 270 hypertensive heart failure patients in the age group of 30 to 75 years of both genders. The participants with evidence of HF were recruited from the Department of Cardiology in a tertiary care hospital in Chennai, India. MicroRNA-210-3p was analyzed by qRT-PCR in a stratified sample of 80 HF patients and 20 apparently healthy individuals. Biomarkers were analyzed by ELISA. Institutional ethics committee approval and written informed consent were obtained. Statistical analysis was performed using R software (4.2.1). Based on the type of distribution of data, appropriate statistical tools were used. p-value ≤  0.05 was considered to be statistically significant.

RESULTS

All the biomarkers including microRNA-210-3p were significantly higher in HFrEF than in HFpEF. MAGGIC score showed a positive correlation with all the biomarkers. The cut-off of microRNA-210-3p was 5.03.

CONCLUSION

All the biomarkers were significantly elevated in HFrEF compared to HFpEF. However, microRNA-210-3p could be an early marker in the diagnosis of heart failure. The strategy of employing a multi-marker approach could help in the early diagnosis as well as in stratifying the HF patients.

Integrative bioinformatic analysis of prognostic biomarkers in heart failure: Insights from clinical trials

BACKGROUND

Heart failure (HF) remains a major cause of morbidity and mortality worldwide. Therefore, there is a need to identify robust biomarkers to improve early diagnosis, stratify disease severity and predict outcomes. Biomarkers such as galectin-3 (Gal-3), TIMP-1, BNP, NT-proBNP, CysC, CA125, ST2 and MMP9 have shown the potential to reflect the pathophysiology of HF. Despite their clinical potential, their integration into routine practice is still limited. The use of bioinformatics may help uncover critical associations between these biomarkers and the progression of HF, providing opportunities for personalized disease management.

METHODS

Following PRISMA guidelines, a systematic review of clinical studies was performed using databases with time constraints. The major proteins associated with HF were identified and their diagnostic and prognostic roles were analysed.

RESULTS

The study emphasizes that galectin-3 (Gal-3) and TIMP-1 serve as key indicators of fibrosis and inflammation, while BNP and NT-proBNP are reliable markers of cardiac stress. Cystatin C (CysC) reflects renal dysfunction, and CA125 correlates strongly with venous congestion. In addition, ST2 and MMP9 provide valuable insights into inflammation and tissue remodelling processes. These biomarkers are consistently elevated in patients with HF, emphasizing their critical role in detecting the systemic and cardiac manifestations of the disease.

CONCLUSION

Our results emphasize the importance of including biomarkers such as Gal-3, TIMP-1, BNP, NT-proBNP, CysC, CA125, ST2 and MMP9 in the diagnosis and treatment of HF. Their upregulation reflects the complex pathophysiological processes of HF and supports their use in the clinical setting to improve diagnostic accuracy, prognostic precision and personalized therapeutic strategies.

Advances in Pathophysiological Mechanisms of Degenerative Aortic Valve Disease

Degenerative aortic valve disease (DAVD) represents the most prevalent valvular ailment among the elderly population, which significantly impacts their physical well-being and potentially poses a lethal risk. Currently, the underlying mechanisms of DAVD remain incompletely understood. While the progression of this disease has traditionally been attributed to degenerative processes associated with aging, numerous recent studies have revealed that heart valve calcification may represent a response of valve tissue to a specific initiating factor, involving the interaction of various genes and signaling pathways. This calcification process is further influenced by a range of factors, including genetic predispositions, environmental exposures, metabolic factors, and hemodynamic considerations. Based on the identification of its biomarkers, potential innovative therapeutic targets are proposed for the treatment of this complex condition. The present article primarily delves into the underlying pathophysiological mechanisms and advancements in diagnostic and therapeutic modalities pertaining to this malady.

Treatment options for heart failure in individuals with overweight or obesity: a review

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

Transition to Advanced Heart Failure: From Identification to Improving Prognosis

Advanced heart failure (AHF) represents the terminal stage of heart failure (HF), characterized by persistent symptoms and functional limitations despite optimal guideline-directed medical therapy (GDMT). This review explores the clinical definition, pathophysiology, and therapeutic approaches for AHF. Characterized by severe symptoms, New York Heart Association (NYHA) class III-IV, significant cardiac dysfunction, and frequent hospitalizations, AHF presents substantial challenges in prognosis and management. Pathophysiological mechanisms include neurohormonal activation, ventricular remodeling, and systemic inflammation, leading to reduced cardiac output and organ dysfunction. Therapeutic strategies for AHF involve a multidisciplinary approach, including pharmacological treatments, device-based interventions like ventricular assisted devices, and advanced options such as heart transplantation. Despite progress, AHF management faces limitations, including disparities in access to care and the need for personalized approaches. Novel therapies, artificial intelligence, and remote monitoring technologies offer future opportunities to improve outcomes. Palliative care, which focuses on symptom relief and quality of life, remains crucial for patients ineligible for invasive interventions. Early identification and timely intervention are pivotal for enhancing survival and functional outcomes in this vulnerable population. This review underscores the necessity of integrating innovative technologies, personalized medicine, and robust palliative strategies into AHF management to address its high morbidity and mortality.

Cardiovascular risk and cardiac involvement in idiopathic inflammatory myopathies: insights from a cross-sectional Swedish single-centre study

OBJECTIVE

We aimed to investigate the cardiovascular profile, including risk factors and cardiovascular abnormalities, in patients with idiopathic inflammatory myopathies (IIMs).

METHOD

In this cross-sectional study, 109 IIM patients and 20 age- and gender-matched healthy controls were enrolled and underwent electrocardiographic and transthoracic echocardiographic examinations. We analysed blood levels of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP), assessed IIM disease-specific features, and evaluated the medical history of cardiovascular risk factors. IIM patients were stratified into two groups: those with previous cardiac involvement and those without.

RESULTS

IIM patients had a higher body mass index (BMI) and a greater prevalence of diabetes mellitus and dyslipidaemia than healthy controls (p = 0.023, p = 0.024, and p = 0.042, respectively). They also showed significantly higher rates of arrhythmia, cardiac axis deviation, negative T-waves, and suspected pulmonary hypertension, along with elevated NT-proBNP levels (p = 0.041, p = 0.004, p = 0.041, p = 0.012, and p = 0.034, respectively). A significantly higher proportion (p = 0.037) of immune-mediated necrotizing myopathy (IMNM) subtype (50%) was found among IIM with previous cardiac involvement compared to those without (20%). cTnI levels were significantly higher in IIM with cardiac involvement than in IIM without cardiac involvement (p = 0.009).

CONCLUSIONS

Cardiovascular complications in patients with IIM may result from an increased prevalence of traditional cardiovascular risk factors, such as higher BMI, diabetes mellitus, and dyslipidaemia, and/or from direct cardiac involvement, such as previous myocarditis. Cardiac involvement in IIM is notably associated with the IMNM subtype.

Knowledge and attitudes of nurses towards telenursing in cardiac care in Al-Ahsa, Saudi Arabia: a cross-sectional study

Objectives

Telenursing in cardiac care leverages technology to support self-care and optimize outcomes for heart failure patients during and beyond the pandemic. This study aims to explore nurse's knowledge and attitudes towards telenursing in cardiac care, examine the correlation between knowledge and attitude, and associate knowledge levels with selected demographic variables.

Methods

A cross-sectional study was conducted, and 149 nurses from Prince Sultan Cardiac Care Center hospitals were randomly selected. The data were collected through a structured questionnaire, including socio-demographic characteristics, knowledge, and attitudes about telenursing.

Results

The mean age of the nurses was 36.17 ± 6.5 years. Most nurses (64.4%) held a bachelor's degree, with 71.8% working as staff nurses. Nearly half (47.6%) had 6-9 years of professional experience. Among them, 15.4% had good knowledge, 63.8% had average knowledge, and 20.8% had poor knowledge, with a total mean knowledge score of 14.92 ± 3.2. Overall, nurses had positive attitudes towards telenursing (p < 0.05). Knowledge scores were significantly associated with age, education, and professional experience (p < 0.05).

Conclusion

Strengthening nurse's understanding of telenursing is vital. Focused educational and training programs are imperative to enhance knowledge about telenursing in cardiac care and alleviate the healthcare system's economic burden.

PGRMC2 is a pressure-volume regulator critical for myocardial responses to stress in mice

Progesterone receptors are classified into nuclear and membrane-bound receptor families. Previous unbiased proteomic studies indicate a potential association between cardiac diseases and the progesterone receptor membrane-bound component-2 (PGRMC2); however, the role of PGRMC2 in the heart remains unknown. In this study, we use a heart-specific knockout (KO) mouse model (MyH6•Pgrmc2flox/flox) in which the Pgrmc2 gene was selectively deleted in cardiomyocytes. Here we show that PGRMC2 serves as a mediator of steroid hormones for rapid calcium signaling in cardiomyocytes to maintain cardiac contraction, sufficient stroke volume, and adequate cardiac output by regulating the cardiac pressure-volume relationship. The KO hearts from male and female mice exhibit an impairment in pressure-volume relationship. Under hypoxic conditions, this pressure-volume dysregulation progresses to congestive left and right ventricular failure in the KO hearts. Overall, we propose that PGRMC2 is a cardiac pressure-volume regulator to maintain normal cardiac physiology, especially during hypoxic stress.

Clinical Performance of an N-Terminal Pro-B-Type Natriuretic Peptide Assay in Acute Heart Failure Diagnosis

BACKGROUND

We evaluated the Vitros® Immunodiagnostic Products N-terminal pro B-type natriuretic peptide (NT-proBNP) II assay for aiding in diagnosis of heart failure (HF) in patients with acute dyspnea.

METHODS

Serum concentrations of NT-proBNP were measured in patient samples from 20 emergency departments across the United States. Study endpoints included sensitivity, specificity, likelihood ratios, and predictive values for diagnosis of acute HF according to age-stratified cutoffs (450, 900, and 1800 pg/mL), and a rule-out age-independent cutoff (300 pg/mL). Additional measures were area under the curve (AUC) for receiver operating characteristic (ROC) curves. Results were also interpreted in patient subgroups with relevant comorbidities, and gray zone/intermediate assay values.

RESULTS

Of 2200 patients, 1095 (49.8%) were diagnosed with HF by clinical adjudication. Sensitivity and specificity for Vitros NT-proBNP II ranged from 84.0% to 92.1%, and 81.4% to 86.5%, respectively, within and across age groups, and positive predictive values were 80.4% to 85.7%. Using the rule-out cutoff, the negative predictive value was 97.9%, with a negative likelihood ratio of 0.02. In subgroups with comorbidities potentially affecting NT-proBNP concentrations, sensitivities ranged from 82.6% to 89.5%, and AUCs for ROC curves were 0.899 to 0.915.

CONCLUSIONS

The Vitros NT-proBNP II assay demonstrated excellent clinical performance using age-stratified cutoffs along with other clinical information for supporting diagnosis of HF, and can rule out HF with a high negative predictive value using the age-independent cutoff. The assay retained utility in patient subgroups with conditions that influence NT-proBNP concentration, and for those with gray zone results.

CLINICALTRIALS.GOV REGISTRATION NUMBER

NCT03548909.

Association Between Two Novel Visceral Obesity Indicators and Heart Failure Among US Adults: A Cross-Sectional Study

Background: This study aimed to explore the association of cardiometabolic index (CMI), CMI-age, visceral adiposity index (VAI), and VAI-age with heart failure (HF) and to compare those indicators for early identification of HF. Methods: Drawing from the National Health and Nutrition Examination Survey (NHANES) for 2011-2018, we enrolled 8999 participants in a cross-sectional study. The association of different visceral obesity indicators (CMI, CMI-age, VAI, and VAI-age) with HF was estimated by multivariable regression analysis. Receiver operating characteristic (ROC) curves were used to examine the predictive ability of CMI, CMI-age, VAI, and VAI-age on patients with HF. Results: CMI, CMI-age, VAI and VAI-age showed positive correlations with HF. When indicators were analyzed as continuous variables, CMI, CMI-age, VAI, and VAI-age showed positive correlations with HF in both the crude and adjusted models (all P < 0.05). When indicators were analyzed as categorical variables, it was found that in all four models, the ORs of group Q4 was significantly different compared to Q1 (all P < 0.05), suggesting the risk of HF is significantly increased with higher CMI, CMI-age, VAI, or VAI-age. The association between those indicators (CMI, CMI-age, VAI, and VAI-age) and HF was similar in all stratified populations (P for interaction >0.05).The areas under the ROC curve (AUCs) of four indicators in predicting HF were significantly different (CMI: 0.610, 95% CI, 0.578-0.643; CMI-age: 0.700, 95% CI, 0.669-0.726; VAI: 0.593, 95% CI, 0.561-0.626; VAI-age: 0.689, 95% CI, 0.661-0.718), suggesting that CMI-age was significantly better than the other three indicators in predicting HF (P < 0.001). Conclusions: CMI, CMI-age, VAI, and VAI-age were all independently correlated with the risk of HF. In four indicators, the CMI-age was significantly better than the other three indicators in predicting HF, which provides new insights into the prevention and management of HF.

Innovations in heart failure management: The role of cutting-edge biomarkers and multi-omics integration

Heart failure (HF) remains a major cause of morbidity and mortality worldwide and represents a major challenge for diagnosis, prognosis and treatment due to its heterogeneity. Traditional biomarkers such as BNP and NT-proBNP are valuable but insufficient to capture the complexity of HF, especially phenotypes such as HF with preserved ejection fraction (HFpEF). Recent advances in multi-omics technology and novel biomarkers such as cell-free DNA (cfDNA), microRNAs (miRNAs), ST2 and galectin-3 offer transformative potential for HF management. This review explores the integration of these innovative biomarkers into clinical practice and highlights their benefits, such as improved diagnostic accuracy, enhanced risk stratification and non-invasive monitoring capabilities. By leveraging multi-omics approaches, including lipidomics and metabolomics, clinicians can uncover new pathways, refine the classification of HF phenotypes, and develop personalized therapeutic strategies tailored to individual patient profiles. Remarkable advances in proteomics and metabolomics have identified biomarkers associated with key HF mechanisms such as mitochondrial dysfunction, inflammation and fibrosis, paving the way for targeted therapies and early interventions. Despite the promising results, significant challenges remain in translating these findings into routine care, including high costs, technical limitations and the need for large-scale validation studies. This report argues for an integrative, multi-omics-based model to overcome these obstacles and emphasizes the importance of collaboration between researchers, clinicians and policy makers. By linking innovative science with practical applications, multi-omics approaches have the potential to redefine HF management and lead to better patient outcomes and more sustainable healthcare systems.

A retrospective study of the association between serum uric acid and risk of coronary heart disease complicated with different types of chronic heart failure

Heart failure (HF) is a terminal stage of cardiovascular diseases, classified based on ejection fraction. Serum uric acid (SUA) has been implicated in the pathogenesis and progression of coronary artery disease (CAD) with HF, yet its predictive value remains unclear. This study aimed to evaluate the predictive role of SUA in the progression of HF in CAD patients and its potential to differentiate HF types. A retrospective analysis was conducted on 342 CAD patients, including 29 with CAD alone and 313 with CAD complicated by varied HF types. Biochemical parameters and HF severity were assessed, and logistic regression analyses were performed to identify independent predictors of HF progression. Significant differences were observed in biochemical parameters, including glutamic-pyruvic transaminase (ALT), glutamic oxalacetic transaminase (AST), alkaline phosphatase (ALP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), creatine kinase-MB (CK-MB), SUA, lactate dehydrogenase (LDH), myoglobin (MTO), between groups. SUA levels were significantly higher in CAD patients with HF, particularly in those with reduced ejection fraction. Univariate and multivariate logistic regression analyses identified history of hypertension, AST, and SUA as independent predictors of HF progression, with SUA showing the highest odds ratio. In addition, SUA levels were positively correlated with Gensini scores, indicating its association with CAD severity. SUA is a strong predictor of HF progression in CAD patients, especially for patients with HFrEF, which can serve as a diagnostic and prognostic marker for HF progression in CAD patients.

The clinical value of α-hydroxybutyrate dehydrogenase, cardiac troponin I, and B-type natriuretic peptide in perioperative diagnosis of heart failure in children with congenital heart disease

Objective

This study evaluates the clinical value of α-Hydroxybutyrate Dehydrogenase (α-HBDH), Cardiac Troponin I (cTnI), and B-Type Natriuretic Peptide (BNP) in the perioperative diagnosis of heart failure in children with congenital heart disease (CHD).

Methods

A retrospective analysis was performed on data from 107 children with CHD who underwent surgery between March 2022 and March 2023. Patients were categorized based on the European Society of Cardiology (ESC) cardiac function grading into three groups (Grades I-III) and further into heart failure (HF) and non-HF groups. Preoperative and postoperative levels of α-HBDH, cTnI, and BNP were compared across cardiac function grades and HF status. The diagnostic value of these biomarkers was assessed using receiver operating characteristic (ROC) curve analysis.

Results

Preoperative levels of α-HBDH, cTnI, and BNP were significantly higher in the HF group than in the non-HF group (all P < 0.05). These markers also increased with cardiac function severity, being highest in Grade III. Postoperatively, α-HBDH, CKMB, and BNP remained elevated in severe cases, correlating with worsening function (all P < 0.05). The ROC analysis showed that among the preoperative cardiac biomarkers in children with CHD, whether assessed individually or in combination, the combined detection of cTnI and BNP exhibited the highest diagnostic value for perioperative heart failure, with an AUC of 0.883.

Conclusion

In children with CHD, preoperative levels of α-HBDH, cTnI, and BNP during the perioperative period are closely correlated with cardiac function, significantly increasing with the severity of cardiac dysfunction. These biomarkers have important clinical value for diagnosing heart failure, with the combined detection of cTnI and BNP demonstrating the highest diagnostic efficacy.

Effect of proton pump inhibitor (lansoprazole) on adverse drug reactions and rational drug use in elderly patients with chronic heart failure

OBJECTIVE

To evaluate the efficacy and rationale of proton pump inhibitors (PPIs) for adverse drug reactions in elderly patients with heart failure (HF).

METHODS

From February 2019 to September 2021, 120 elderly patients with chronic heart failure (CHF) treated at Jintan First People's Hospital were enrolled as subjects. The patients were classified into a control group (n=60) and a research group (n=60). In addition to clopidogrel, the control group received cimetidine, while the research group received lansoprazole. Clinical efficacy, oxidative stress markers, echocardiographic indices, vascular endothelial function, cardiac function indicators, and adverse reactions were compared between the two groups. A cost-effectiveness analysis was also performed, and risk factors affecting patient efficacy were examined.

RESULTS

The clinical efficacy of the research group was remarkably superior to that of the control group (88.33% versus 63.33%, P<0.05). The combination of clopidogrel and cimetidine was identified as a risk factor affecting patient efficacy (P=0.003). Besides, the research group showed significant elevation in superoxide dismutase (SOD), glutathione peroxidase (GPx), left ventricular ejection fraction (LVEF), and nitric oxide (NO) after treatment, all higher compared to the control group (all P<0.05). Additionally, significant reductions in malondialdehyde (MDA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic dimension (LVSD), endothelin-1 (ET-1), N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase (CK), lactate dehydrogenase (LDH), and free fatty acids (FFA) were observed in the research group, all lower than the control group (P<0.05). The incidence of bradycardia, hypotension and electrolyte disturbances in the research group was remarkably lower (P<0.05). Additionally, the research group demonstrated greater cost-effectiveness compared to the control group.

CONCLUSION

The use of PPIs in elderly patients with HF not only improves efficacy but also enhances safety, making this drug treatment approach worth promoting.

Short-Chain Fatty Acids and Their Metabolic Interactions in Heart Failure

Short-chain fatty acids (SCFAs), produced through fermentation of dietary fibers by gut bacteria, play a central role in modulating cardiovascular function and heart failure (HF) development. The progression of HF is influenced by intestinal barrier dysfunction and microbial translocation, where SCFAs serve as key mediators in the gut-heart axis. This review examines the complex metabolic interactions between SCFAs and other gut microbiota metabolites in HF, including their relationships with trimethylamine N-oxide (TMAO), aromatic amino acids (AAAs), B vitamins, and bile acids (BAs). We analyze the associations between SCFA production and clinical parameters of HF, such as left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and glomerular filtration rate (GFR). Gaining insights into metabolic networks offers new potential therapeutic targets and prognostic markers for managing heart failure, although their clinical significance needs further exploration.

miR-30d Levels Predict Re-Hospitalization in Patients with Acute Cardiogenic Pulmonary Edema: A Preliminary Study

Acute cardiogenic pulmonary edema (ACPE) is a common and serious manifestation of heart failure (HF), representing 10-20% of all acute HF admissions. It is associated with elevated in-hospital mortality and high rates of re-hospitalization. MicroRs, like miR-30d, are of particular interest in heart failure due to their regulatory role in gene expression and potential as biomarkers for diagnosing and predicting patient outcomes, especially in high-risk cases such as ACPE. We conducted a cohort study on patients diagnosed with ACPE in the Emergency Department (ED). The circulating levels of miR-30d were analyzed at the time of hospital admission and at one-month follow-up along with other biomarkers. We enrolled 24 ACPE patients and 10 control subjects. Median age was 80.8 years (interquartile range, IQR, 8.2) in ACPE cases, and 78.5 years (IQR 9.8) in controls with a male/female ratio of 2 and 0.66, respectively. In ACPE patients, median cardiac ejection fraction was 42.5%, creatinine 1.63 mg/dL (IQR 1.24), troponin 63.5 ng/dL (58), and NT-proBNP 4243.5 pg/mL (IQR 5846) at ED evaluation. Median concentration of miR30d was 0.81 in controls, and 3.67 and 7.28 in ACPE patients at enrollment time and one month later, respectively. Re-hospitalization occurred in 7 ACPE patients in the following 3 months, and in 9 during the following year. miR-30d had a significant predictive value in assessing the risk of re-hospitalization at both 3 months and 1 year following the initial diagnosis of ACPE, while it did not in assessing the risk of death at 1 year. When compared with the other biomarkers, none of them showed a better accuracy than miR-30d. Our findings suggest that elevated levels of miR-30d are associated with an increased rate of hospital readmission at both 3 months and 1 year after discharge. Larger, multicenter studies will be needed to confirm the validity of circulating miR-30d levels as a potential biomarker useful for risk prediction in ACPE patients and its utility in improving individualized patient care.

Study on forensic diagnostic biomarker combination for acute ischemia heart disease based on postmortem biochemistry

Sudden cardiac death (SCD) caused by ischemia heart disease (IHD) has traditionally been identified through autopsy and microscopic examination. However, these methods are limited in diagnosing cases of acute ischemia heart disease (AIHD) without typical myocardial necrosis and excessive reliance on the subjective experience of experts. Postmortem biochemistry is crucial in the assisted diagnosis of SCD in forensic medicine. We evaluated the expression levels of six sensitive biomarkers of myocardial injury in the training-set comprising 78 cases of acute ischemia (AI), 23 cases of acute myocardial infarction (MI), and 37 cases who died of high falls. The results showed that CK-MB, cTnI, BNP, LDH, and HBDH may be of great significance in diagnosing sudden death of AIHD. Among these, BNP, LDH, and HBDH are particularly useful for distinguishing between AI and acute MI. Using receiver operating analysis, we identified that the combination of five biomarkers-BNP, cTnI, CK-MB, LDH, and HBDH-achieved a significantly higher diagnostic accuracy for AIHD, with an AUC of 0.910. This combination outperformed the traditional three-biomarker combination (CK-MB, cTnI, BNP), which was considered highly accurate but only had an AUC of 0.857. Additionally, a three-biomarker combination (BNP, HBDH, and LDH) demonstrated clear advantages in differentiating between AI and acute MI, with an AUC of 0.794. Validation-set results proved that the strategy of finding the unique combination based on postmortem biochemistry is effective. It can provide valuable information for the discrimination of AIHD and the identification of AI and acute MI.

Interleukin-38 as a potential diagnostic biomarker for heart failure

OBJECTIVE

Interleukin-38 (IL-38) attenuates inflammation, myocardial injury, and ventricular remodeling after myocardial infarction, which potentially reduces the incidence of heart failure (HF). This study aimed to evaluate the diagnostic value of IL-38 for HF.

METHODS

IL-38 was detected via enzyme-linked immunosorbent assay in the serum samples of 238 hF patients and 30 healthy controls when enrollment.

RESULTS

IL-38 was elevated in HF patients compared with controls (p = 0.002). Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of IL-38 for predicting HF risk was 0.676 (95% confidence interval = 0.594-0.758). The Youden index of IL-38 for diagnosing HF peaked at 0.329 when the cutoff value of IL-38 was set as 6 ng/mL, with sensitivity and specificity of 0.833 and 0.496, respectively. Before (odds ratio = 1.493, p = 0.002) and after (odds ratio = 1.500, p = 0.007) adjustment of age and gender by multivariable regression analysis, IL-38 was associated with a higher HF risk. Moreover, the combination of IL-38 with age and gender possessed a good value for predicting HF risk (AUC = 0.796, 95% confidence interval = 0.706-0.885).

CONCLUSION

IL-38 is increased in HF patients compared with controls, and its combination with age and gender shows a good value for the diagnosis of HF.

Circulating bone morphogenetic protein 10 as a novel marker of atrial stress and remodelling in heart failure

BACKGROUND

We evaluated the potential of circulating bone morphogenetic protein 10 (BMP10) as a biomarker for atrial stress and remodelling in patients with heart failure (HF), in comparison to N-terminal pro-B-type natriuretic peptide (NT-proBNP). We also assessed the predictive value of BMP10 for adverse clinical outcomes.

METHODS

BMP10 levels were quantified in 2085 chronic HF patients from the European BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) cohort and in 1487 patients from the Scottish validation cohort. Multivariable linear regression identified independent associates of BMP10. Proteomic analysis of 6369 proteins with subsequent gene set enrichment analysis was used to explore biological pathways associated with elevated BMP10. Cox proportional hazards models adjusting for established risk factors were used to associate BMP10 levels with clinical outcomes, including all-cause mortality and HF hospitalisation.

RESULTS

In a multivariable model including clinical and echocardiographic parameters, log-transformed and standardised BMP10 levels were significantly associated with a history of atrial fibrillation (Sβ=0.419; p<0.001), and with echocardiographic features reflecting atrial stress, such as increased left atrial diameter (Sβ=0.075; p=0.048). By contrast, these were not among the strongest associates of NT-proBNP levels. Gene set enrichment analysis showed significant overrepresentation in pathways of muscle contraction and extracellular matrix organisation. Higher log-transformed and standardised BMP10 levels predicted a combined outcome of 2-year all-cause mortality and HF rehospitalisation (HR=1.10, 95% CI=1.02-1.19), with the validation cohort yielding comparable results.

CONCLUSION

BMP10 emerges as a novel biomarker reflecting atrial stress and remodelling in chronic HF patients. Its additional predictive value for adverse outcomes underscores its potential utility in enhancing risk stratification and guiding therapeutic interventions in HF management.

Mid-Regional Pro-Adrenomedullin Is Associated with Adverse Cardiovascular Outcomes After Cardiac Surgery

Background: In the era of personalized medicine, tools for risk stratification after cardiovascular interventions are crucial to reduce mortality and morbidity, especially in the aging population. Biomarker-based approaches, in particular, have gained significant importance. Mid-regional pro-adrenomedullin (MR-proADM) represents an easily assessable biomarker that mirrors cardiac function and fibrosis. Therefore, we aimed to investigate the prognostic potential of MR-proADM in patients undergoing elective cardiac surgery. Methods: Patients undergoing elective cardiac bypass and/or valve surgery were prospectively enrolled between May 2013 and August 2018. The primary endpoint was the composite of hospitalization for heart failure (HHF) or cardiovascular (CV) mortality. Results: In total, 500 patients (146 female [29.2%]; median age 69.8 years (IQR 60.6-75.5 years) were included. Individuals were stratified into risk categories based on their MR-proADM values (Low Risk ≤ 0.63 nmol/L, Intermediate Risk > 0.63 and ≤0.84, High Risk > 0.84). A significant increase in 5-year event rates for HHF/CV mortality in patients in the high-risk category (Low Risk 8.6% vs. High Risk 37.7%, p < 0.001) was observed. MR-pro ADM showed an independent association with HHF/ CV mortality (adjusted HR of 3.43, 95% CI 1.83-6.42; p < 0.001 comparing the High-Risk group to the Low-Risk group). Conclusions: MR-pro ADM was found to be a strong and independent predictor for HHF/CV mortality in patients undergoing elective cardiac surgery. Considering a personalized diagnostic and prognostic work-up, a standardized preoperative evaluation of MR-proADM levels might help to identify patients at risk for major adverse events and early re-hospitalization.

Mendelian Randomization Study Reveals Causal Pathways for Hypertrophic Cardiomyopathy, Cardiovascular Proteins, and Atrial Fibrillation

Aims/Background Research evidence has demonstrated a significant association between hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), but the causality and pattern of this link remain unexplored. Therefore, this study investigated the causal relationship between HCM and AF using a two-sample and bidirectional Mendelian randomization (MR) approach. Additionally, this assessed the role of cardiovascular proteins (CPs) associated with cardiovascular diseases between HCM and AF by applying a two-step MR analysis. Methods Data for HCM, AF, and 90 CPs were obtained from the Finn Gen and IEU Open GWAS Project databases. MR-Egger, inverse variance weighting (IVW), weighted median estimator (WME), weighted mode, and simple mode were used to estimate causal inferences. Furthermore, Cochran's Q test, MR-Egger's intercept terms, and Leave-one-out methods determined the heterogeneity, horizontal pleiotropy, and sensitivity. Additionally, mediation effects were used to assess the role of CPs in the relationship between HCM and AF. Results Two-sample and bidirectional MR analysis revealed HCM as a risk factor for AF (odds ratio (OR) = 1.008, 95% confidence interval (CI): 1.001-1.016, p = 0.029) and AF was found to increase the risk of developing HCM (OR = 1.145, 95% CI: 0.963-1.361, p = 0.126). Moreover, Two-step MR analyses indicated that 5 CPs were causally associated with HCM; 12 CPs with AF and 1 CP (Melusin) with both HCM and AF. Additionally, Melusin was observed as a protective factor for both HCM and AF and may serve as a mediator variable for these two conditions (mediation effect 0.0004, mediation ratio 5.5178%, 95% CI: 5.4624-5.5731). Conclusion HCM may increase the risk of developing AF, with Melusin serving as a mediator for this risk.

The value of growth differentiation factor 15 as a biomarker for peripheral artery disease in diabetes patients

BACKGROUND

Growth differentiation factor 15 (GDF15) is significantly correlated with glycolipid metabolic disorders. Increased GDF15 levels are associated with obesity, insulin resistance, and diabetes as well as a poorer diabetes progression and prognosis. This is a prospective cohort study investigated the association between circulating GDF15 and diabetic peripheral artery disease.

METHODS

A total of 174 diabetic patients aged 20-80 were enrolled. Plasma GDF15 levels were measured using ELISA. Peripheral Artery Disease (PAD) was evaluated with the Ankle brachial index (ABI) and the Cardio-ankle vascular index (CAVI).

RESULTS

We found that diabetic patients with higher serum GDF15 levels (mean: 2521.5 pg/mL) had a higher incidence of peripheral artery disease. Multivariate logistic regression analysis indicated that patients with high serum GDF15 levels were at an increased risk of developing peripheral artery disease. High GDF15 levels were associated with ABI < 0.9 (right and left mean 19.5% p = 0.80, OR:1.13; 95%CI: [0.44-2.90]). Increased age (p = 0.025 OR:1.02; 95% CI [0.13-0.87]), family history (p = 0.001 OR:1.37; 95%CI: [0.37-5.05]), heart failure (p = 0.002 OR:4.96; 95%CI: [1.76-13.97]), sodium-glucose linked transporter 2 (SGLT 2) inhibitor use (p = 0.026), estimated glomerular filtration rate (eGFR) (p = < 0.001), and uric acid (p = < 0.001) was also positively associated with high GDF15 levels. Urine albumin-to-creatinine ratio (UACR) (p = < 0.010) was associated with higher GDF15 levels after one year of follow up.

CONCLUSIONS

Elevated GDF15 was significantly associated with worsening metabolic parameters and an increased risk of peripheral artery disease. Thus, it may be a stronger predictor of these outcomes in people with diabetes.

Evaluation of urinary density as a biomarker for the diagnosis of acute heart failure

Background

Heart failure (HF) has become a public healthcare concern with significant costs to countries because of the aging world population. Acute heart failure (AHF) is a common condition faced frequently in emergency departments, and patients often present to hospitals with complaints of breathlessness. The patient must be evaluated with anamnesis, physical examination, blood, and imaging results to diagnose AHF. Brain natriuretic peptide (BNP) is a widely accepted biomarker for the diagnosis of HF.

Methods

The files of the patients who applied to the emergency department with complaints of breathlessness were scanned, and BNP and urinary density (UD) levels were evaluated for the diagnosis of HF in patients.

Results

The results support that BNP is an effective biomarker in AHF, as is widely accepted. When the correlation between BNP and UD measurements was examined in the present study, a negative correlation was detected between the parameters. The results also suggested that low UD values may help diagnose AHF.

Conclusion

If similar results are obtained in prospective multicenter studies with the participation of more patients, UD value can be used as a biomarker for the diagnosis of AHF.

High mRNA Expression of 24 Dehydrocholesterol Reductase (DHCR24) in the Treatment of Doxorubicin-Induced Heart Failure in Rats

OBJECTIVE

The objective of this study was to explore the possibility of treating heart failure in rats by delivering mRNA of 24-dehydrocholesterol reductase (DHCR24) into the body through lipid nanoparticles (LNPs).

METHODS

We established a heart failure rat model using doxorubicin. The experiment was divided into blank, model, mRNA stock solution cardiac injection, mRNA stock solution intravenous injection, LNP-mRNA stock solution cardiac injection, and LNP-mRNA stock solution intravenous injection groups. We directly injected DHCR24-mRNA or LNP-DHCR24-mRNA into the myocardium in three regions through an insulin needle passing through the intercostal space under the guidance of B-ultrasound. We recorded the mortality rate, body weight, 6-min walk test return times, and organ weight of rats after administration and detected the cardiac structure and function using B-ultrasound and transmission electron microscopy (TEM). Additionally, we tested for HE staining; PRDX2, Sirt3, and TRX1 protein expression; and IL-1 β, IL-10, VEGF, NT proBNP, and BNP cytokine concentrations.

RESULTS

Compared with the model group, the administration of DHCR24-mRNA significantly reduced mortality; decreased weight loss, the ratio of heart to tibia length, and spleen weight; and improved rat motility. The administration of DHCR24-mRNA can postpone the pathological morphological alterations of myocardial cells and reduce inflammatory infiltration. In terms of biochemistry, the administration of DHCR24-mRNA can increase the expression of the PRDX2, Sirt3, and TRX1 proteins; increase the concentrations of IL-10 and VEGF; and reduce the concentrations of IL-1β, NT proBNP, and BNP. The administration of DHCR24-mRNA can also delay the process of heart failure. The delivery and therapeutic effect of DHCR24-mRNA encapsulated in LNPs were better when compared to the other groups.

CONCLUSIONS

DHCR24-mRNA encapsulated in LNPs can be effectively administered to rats with heart failure and exhibits some curative effects.

Implantation of porcine amniotic epithelial cells model for myocardial infarction combined with cardiomyocyte therapy of pigs (Sus scrofa domestica)

Background

Myocardial infarction (MI) is the most common heart disorder in patients with cardiovascular disease. Obstruction of blood flow to the heart causes ischemia and results in heart pump failure.

Aim

This study aims to evaluate the effects of porcine amniotic epithelial cell (pAEC)-based stem cell therapy alone and in combination with cardiomyocytes to understand its potential benefits in MI treatment.

Methods

In this study, we conducted MI therapy using pluripotent stem cells derived from the amnion (AEC) implanted into the infarcted heart. Nine domestic pigs (Sus scrofa domestica), aged 3-4 months and weighing 35-40 kg, were used as models. The animal models were divided into three groups: the placebo MI group, the MI group treated with pAEC stem cells, and the MI group treated with amniotic epithelial stem cells combined with cardiomyocyte cells. Electrocardiography (ECG), pulsed wave (PW) Doppler, and biomarker examinations were performed to evaluate the effects of stem cell intervention on MI.

Results

Single pAEC stem cell therapy and its combination with cardiomyocytes in MI lesions demonstrated improvements in VTI, particularly renal artery, mitral, and tricuspid valve compared to untreated infarction (placebo). Notably, single pAEC therapy significantly improved more than combining them with cardiomyocytes.

Conclusion

Treatment with AEC stem cells alone resulted in more significant improvements in heart valve function and large blood vessels compared to combining AEC with cardiomyocytes. This study allowed us to understand better the effects of stem cell therapy on blood hemodynamics and biomarker parameters of heart injury.

Implantation of porcine amniotic epithelial cells model for myocardial infarction combined with cardiomyocyte therapy of pigs (Sus scrofa domestica)

Background

Myocardial infarction (MI) is the most common heart disorder in patients with cardiovascular disease. Obstruction of blood flow to the heart causes ischemia and results in heart pump failure.

Aim

This study aims to evaluate the effects of porcine amniotic epithelial cell (pAEC)-based stem cell therapy alone and in combination with cardiomyocytes to understand its potential benefits in MI treatment.

Methods

In this study, we conducted MI therapy using pluripotent stem cells derived from the amnion (AEC) implanted into the infarcted heart. Nine domestic pigs (Sus scrofa domestica), aged 3-4 months and weighing 35-40 kg, were used as models. The animal models were divided into three groups: the placebo MI group, the MI group treated with pAEC stem cells, and the MI group treated with amniotic epithelial stem cells combined with cardiomyocyte cells. Electrocardiography (ECG), pulsed wave (PW) Doppler, and biomarker examinations were performed to evaluate the effects of stem cell intervention on MI.

Results

Single pAEC stem cell therapy and its combination with cardiomyocytes in MI lesions demonstrated improvements in VTI, particularly renal artery, mitral, and tricuspid valve compared to untreated infarction (placebo). Notably, single pAEC therapy significantly improved more than combining them with cardiomyocytes.

Conclusion

Treatment with AEC stem cells alone resulted in more significant improvements in heart valve function and large blood vessels compared to combining AEC with cardiomyocytes. This study allowed us to understand better the effects of stem cell therapy on blood hemodynamics and biomarker parameters of heart injury.

Combination of sST2/LVMI Ratio and Modified MELD Scores Predicts Mortality in End-Stage Heart Failure

Biomarkers are critical for heart failure (HF) management by facilitating risk stratification, therapeutic decision-making, and monitoring treatment response. This prospective, single-center study aimed to assess predictors of death during one-year follow-up in patients with end-stage HF, with particular emphasis on the soluble suppression of tumorigenicity 2/left ventricular mass index (sST2/LVMI) ratio, modified Model for End-stage Liver Disease (modMELD), and Model for End-stage Liver Disease excluding INR (MELD-XI). This study comprised 429 consecutive patients with end-stage HF hospitalized between 2018 and 2023. The median age was 56.0 (50.0-60.0) years; and 89.2% were male. During the follow-up, 134 (31.2%) patients died. The area under the receiver operating characteristics (ROC) curves showed good predictive powers of sST2/LVMI-MELDXI (AUC: 0.90 [CI: 0.87-0.93]; specificity 85% and sensitivity 80%) and sST2/LVMI-modMELD (AUC: 0.92 [95% CI: 0.90-0.95]; specificity 92%, sensitivity 81%) for assessment of one-year mortality. In conclusion: the sST2/LVMI-modMELD and sST2/LVMI-MELD-XI ratios are independently related to one-year mortality in the analyzed group of patients. The prognostic power of these new models is significantly better than their individual components. This single-center study comprised a relatively small group of patients, so the prognostic value of these new models cannot be generalized to the entire HF population. Considering the limitations of this analysis, further randomized trials with a large cohort are necessary to confirm the utility of the new prognostic models in HF patients.

Method Evaluation of the QuidelOrtho Diagnostics Vitros NT-proBNP II Assay

Background/Objectives: N-terminal-proBNP (NT-proBNP) is a biomarker released into the blood in response to heart failure, reflecting the extent of cardiac stress and damage. QuidelOrtho Diagnostics released its latest reformulation of its NT-proBNP assay, the Vitros NT-proBNP II assay. This study aims to evaluate the analytical performance of the Vitros NT-proBNP II assay. Methods: Repeatability, reproducibility, carryover, analytical measurement range, and clinical reportable range (AMR and CRR) were assessed using commercially available materials and dilution of patient specimens. Accuracy was evaluated by comparing results from the Vitros NT-proBNP II and the Vitros NT-proBNP assays. Paired heparin and EDTA plasma specimen results were compared, and instrument-to-instrument comparison was performed using two different Vitros 5600 Integrated Systems. NT-proBNP stability was evaluated at room temperature, 2-8 °C, and -18 °C for up to five days. Results: Repeatability and reproducibility were ≤10% CV, and no carryover was observed. The AMR was 20-30,000 pg/mL and dilution up to 80 times was verified. Passing-Bablok analysis showed a significant proportional bias with a slope of 1.37. Instrument-to-instrument and heparin-to-EDTA plasma comparisons showed no significant biases. NT-proBNP is stable up to five days at room temperature, 4 °C, and -20 °C. Conclusions: Our evaluation demonstrated acceptable analytical performances of the Vitros NT-proBNP II assay except for the positive proportional bias compared with the Vitros NT-proBNP assay.

Growth Differentiation Factor 15 as a Marker for Chronic Ventricular Pacing

Background/Objectives: Right ventricular pacing is an effective and safe treatment option for patients experiencing symptomatic bradycardia. However, some individuals may develop left ventricular dysfunction as a consequence. Growth differentiation factor 15 (GDF-15), which is not present in a healthy adult heart, is upregulated in cardiomyocytes in response to various stress stimuli. This study aimed to explore the potential of GDF-15 as a biomarker for chronic right ventricular pacing. Methods: This single-center cross-sectional cohort study analyzed data from 265 consecutive patients (60.4% male) with either single- or dual-chamber pacemakers, all lacking pre-existing heart failure, who attended the outpatient department for routine follow-up. Chronic right ventricular (RV) pacing was defined as pacing exceeding 40% over the past year. Serum samples were collected, and GDF-15 levels were measured using a commercially available immunoassay (R&D Systems Inc., Minneapolis, MN, USA). Student's t-test was utilized to assess group differences, and receiver operating characteristic (ROC) analysis was employed to evaluate diagnostic performance. Results: When stratifying patients by pacing burden, GDF-15 levels were significantly higher in those with pacing over 40% compared to those with 40% or less (789 ± 293 pg/mL vs. 1186 ± 592 pg/mL; p < 0.001). The ROC analysis indicated that GDF-15 serves as a marker for chronic RV pacing, yielding an area under the curve of 0.713 (95% confidence interval 0.650-0.776; p < 0.001). Conclusions: This study suggests that GDF-15 may be a valuable biomarker for chronic right ventricular pacing.

MicroRNA and Heart Failure: A Novel Promising Diagnostic and Therapeutic Tool

Heart failure (HF) has a multifaceted and complex pathophysiology. Beyond neurohormonal, renin-angiotensin-aldosterone system, and adrenergic hyperactivation, a role for other pathophysiological determinants is emerging. Genetic and epigenetic factors are involved in this syndrome. In many maladaptive processes, the role of microRNAs (miRNAs) has been recently demonstrated. MiRNAs are small endogenous non-coding molecules of RNA involved in gene expression regulation, and they play a pivotal role in intercellular communication, being involved in different biological and pathophysiological processes. MiRNAs can modulate infarct area size, cardiomyocytes restoration, collagen deposition, and macrophage polarization. MiRNAs may be considered as specific biomarkers of hypertrophy and fibrosis. MiRNAs have been proposed as a therapeutical tool because their administration can contrast with myocardial pathophysiological remodeling leading to HF. Antimir and miRNA mimics are small oligonucleotides which may be administered in several manners and may be able to regulate the expression of specific and circulating miRNAs. Studies on animal models and on healthy humans demonstrate that these molecules are well tolerated and effective, opening the possibility of a therapeutic use of miRNAs in cases of HF. The application of miRNAs for diagnosis, prognostic stratification, and therapy fits in with the new concept of a personalized and tailored approach to HF.

Identification of transcription factor-lipid droplet-related gene biomarkers for the prognosis of post-acute myocardial infarction-induced heart failure

Introduction

Patients with acute myocardial infarction (AMI) are at high risk of progressing to heart failure (HF). Recent research has shown that lipid droplet-related genes (LDRGs) play a crucial role in myocardial metabolism following MI, thereby influencing the progression to HF.

Methods

Weighted gene co-expression network analysis (WGCNA) and differential expression gene analysis were used to screen a transcriptome dataset of whole blood cells from AMI patients with (AMI HF, n = 16) and without progression (AMI no-HF, n = 16). Functional enrichment analysis were performed to observe the involved function. Machine learning methods were used to screen the genes related to prognosis. Transcriptional factors (TF) were predicted by using relevant databases. ROC curves were drawn to evaluate the TF-LDRG pair in predicting HF in the validation dataset (n = 16) and the clinical trial (n = 13).

Results

The 235 identified genes were primarily involved in pathways related to fatty acid and energy metabolism. 22 genes were screened out that they were strongly associated with prognosis. 35 corresponding transcription factors were predicted. The TF-LDRG pair, ABHD5-ARID3a, was demonstrated good predictive accuracy.

Discussion

Our findings suggest that ABHD5-ARID3a have significant potential as predictive biomarkers for heart failure post-AMI which also provides a foundation for further exploration into the molecular mechanisms underlying the progression from AMI to HF.

Impact of Exercise on Physiological, Biochemical, and Analytical Parameters in Patients with Heart Failure with Reduced Ejection Fraction

Heart failure with reduced ejection fraction (HFrEF) is a condition marked by diminished cardiac output and impaired oxygen delivery to tissues. Exercise, once avoided in HFrEF patients due to safety concerns, is now recognized as an important therapeutic intervention. Structured exercise improves various physiological, biochemical, and analytical parameters, including cardiac output, endothelial function, skeletal muscle performance, and autonomic regulation. Biochemically, exercise induces favorable changes in inflammatory markers, lipid profiles, glucose metabolism, and renal function. This paper reviews these changes, highlighting how exercise can be safely incorporated into HFrEF management. Further research is needed to tailor exercise interventions for individual patients to optimize outcomes.

Triglyceride-glucose index trajectories predict adverse cardiovascular outcomes in elderly heart failure patients with Diabetes: A retrospective cohort study

Objective

Evaluating the change trajectories of triglyceride-glucose (TyG) index calculated after multiple tests in elderly heart failure (HF) patients may have clinical implications for predicting long-term adverse cardiovascular events (MACEs).

Methods

This retrospective study included 1184 elderly HF (LVEF ≥50%) patients with diabetes admitted to our center between January 2015 and January 2020. Based on the multiple TyG levels detected during the exposure period with annual measurements, three distinct TyG trajectories were determined using latent mixture modeling: low-stable group (TyG index <8.26, n = 367), medium-stable group (TyG index 8.26-9.06, n = 613), and high-increasing group (TyG index >9.06, n = 204). The primary endpoint was the composite outcome of MACEs.

Results

There were significant increases in the prevalence of several cardiovascular risk factors and conditions, such as male gender, BMI, current smoker, hyperlipidemia, atrial fibrillation, old myocardial infarction, fasting glucose, triglycerides, and uric acid levels, from the Low-Stable Group to the High-Increasing Group (all P < 0.05). During a median follow-up of 29 months (range, 18-46 months), 181 MACEs occurred. Kaplan-Meier analyses curve showed a significantly increased risk of MACEs in the medium-stable and high-increasing groups compared to the low-stable group (HR = 2.528, 95%CI: 1.665-3.838; HR = 2.706, 95%CI: 1.722-4.255, respectively). Furthermore, the rates of heart failure-related hospitalizations, nonfatal myocardial infarctions and non-fatal stroke were significantly increased in the medium-stable and high-increasing groups. Multivariable Cox regression analyses revealed that age (HR = 1.728), current smoker (HR = 1.385), old myocardial infarction (HR = 1.593), chronic renal disease (HR = 1.682), HbA1c (HR = 1.816), NT-proBNP (HR = 2.471), TyG trajectory (HR = 2.112) and SGLT2 inhibitors (HR = 0.841) were independently associated with the occurrence of MACEs during follow-up (P < 0.05).

Conclusions

The TyG trajectory is strongly associated with the risk of MACEs during follow-up in elderly patients with T2DM, suggesting that TyG trajectories may further optimize risk stratification model of cardiovascular events.

SREBP1 induction mediates long-term statins therapy related myocardial lipid peroxidation and lipid deposition in TIIDM mice

Statins therapy is efficacious in diminishing the risk of major cardiovascular events in diabetic patients. However, our research has uncovered a correlation between the prolonged administration of statins and an elevated risk of myocardial dysfunction in patients with type II diabetes mellitus (TIIDM). Here, we report the induction of sterol regulatory element-binding protein 1 (SREBP1) activation, associated lipid peroxidation, and the consequent diabetic myocardial dysfunction after statin treatment and explored the underlying mechanisms. In db/db mice, we observed that 40 weeks atorvastatin (5 and 10 mg/kg) and rosuvastatin (20 mg/kg) administration exacerbated diabetic myocardial dysfunction by echocardiography and cardiomyocyte contractility assay, increased myocardial inflammation and fibrosis as shown by CD68, IL-1β, Masson's staining and Collagen1A1 immunohistochemistry (IHC) staining, increased respiratory exchange ratio (RER) by metabolic cage system assessment, exacerbated mitochondrial structural pathological changes by transmission electron microscopy (TEM) examination, increased deposition of lipid and glycogen by TEM, Oil-red and periodic acid-schiff stain (PAS) staining, which were corresponded with augmented levels of myocardial SREBP1 protein and lipid peroxidation marked by 4-hydroxynonenal (4-HNE) staining. Comparable myocardial fibrosis was also observed in KK-ay and low-dose streptozotocin (STZ)-induced TIIDM mice. Elevated SREBP1 levels were observed in the heart tissues from diabetic patients, which was positively correlated with their myocardial dysfunction. To elucidate the role of statin induced SREBP1 in lipid peroxidation and lipid deposition and related mechanism, we cultured neonatal mouse primary cardiomyocytes (NMPCs) and treated them with atorvastatin (10 μM, 24 h), tracing with [U-13C]-glucose and evaluating for SREBP1 expression and localization. We found that statin treatment elevated de novo lipogenesis (DNL) and the levels of SREBP1 cleavage-activating protein (SCAP), reduced the interaction of SCAP with insulin-induced gene 1 (Insig1), and enhance SCAP/SREBP1 translocation to the Golgi, which facilitate SREBP1 cleavage leading to its nuclear trans-localization and activation in NMPCs. Ultimately, SREBP1 knockdown or l-carnitine mitigated long-term statins therapy induced lipid peroxidation and myocardial fibrosis in low-dose STZ treated SREBP1+/- mice and l-carnitine treated db/db mice. In conclusion, we demonstrated that statin therapy may augment DNL by activating SREBP1, resulting in myocardial lipid peroxidation and lipid deposition.

Up-to-date advance in the relationship between obstructive sleep apnea and heart failure: a narrative review

PURPOSE

Obstructive sleep apnea (OSA) is recognized as an independent and significant risk factor for various cardiovascular and cerebrovascular conditions, including heart failure (HF). In this review, we explore the impact of OSA on HF, examine shared contributing factors and underlying pathophysiological mechanisms, and assess the treatment options for OSA and their potential therapeutic value in HF patients.

METHODS

Pubmed/MEDLINE were searched through September 2024 to explore the relationship between OSA and HF. The relevant papers included OSA and HF, risk factors of OSA and HF, and the prognosis and treatment of HF patients with OSA.

RESULTS

The results showed that OSA increased the risk of HF. OSA can exacerbate or contribute to the onset of HF in several ways. The application of continuous positive airway pressure (CPAP) and other treatments may benefit HF patients with OSA. Drug therapy has shown promise for treating OSA, extensive multi-center studies remain essential, particularly in patients with both OSA and HF.

CONCLUSION

OSA can exacerbate or contribute to the onset and recurrence of HF in several ways. Further studies should be carried out to explore effective treatments in patients with HF and OSA.

Long-term surrogate cardiovascular outcomes of SGLT2 inhibitor empagliflozin in chronic heart failure: a systematic review and meta-analysis

The sodium‒glucose cotransporter-2 (SGLT2) inhibitor empagliflozin (EMPA) has been demonstrated to reduce the risk of cardiovascular mortality or hospitalization for heart failure (HF) in patients. Nevertheless, data concerning the long-term cardiovascular effects in clinically important subgroups are scarce. A prespecified meta-analysis of randomized controlled trials (RCTs) was conducted to assess the long-term effects of EMPA on cardiovascular outcomes in HF patients, regardless of HF type and glycemic status. The assessment included parameters related to left ventricular (LV) remodeling, including the LV volume, the LV mass index (LVMI), the ejection fraction, the systolic blood pressure, and biomarkers. Moreover, the effects of the treatment on exercise capacity and quality of life (QoL) were analyzed. Furthermore, these cardiovascular parameters were evaluated in prespecified subgroups of HF patients, including type of HF, type 2 diabetes status, and duration of therapy. The quantitative meta-analysis was synthesized and analyzed via the statistical software Stata 17.0. The meta-analysis revealed that EMPA administration significantly contributed to a reduction in systolic blood pressure (SBP) (MD = 4.93 mmHg, 95% CI=[-9.67, -0.19]; P < 0.0001) and left ventricular end-diastolic volume (LVEDV) (MD=-18.03 mL, 95% CI=[-25.4, -10.67], P < 0.0001). Furthermore, left ventricular end-systolic volume (LVESV) (MD=-16.09 mL, 95% CI=[-26.94, -5.25]; P < 0.0001) and N-terminal pro-B-type NP (NT-proBNP) (SMD=-0.54, 95% CI=[-0.94, -0.13]; P = 0.01) significantly decreased. These decreases were accompanied by improvements in the 6-minute walk distance (6MWD, SMD = 0.78, 95% CI=[-0.22, -1.79], P = 0.13) and KCCQ score (MD = 1.98, 0.97-2.99; P < 0.0001). The results of the subgroup analysis indicated that EMPA administration was associated with more pronounced benefits in terms of cardiac remodeling, function and exercise capacity for specific populations, including (1) HF with a reduced ejection fraction (HFrEF); (2) the absence of diabetes; and (3) treatment for no less than 6 months. Additionally, EMPA may lead to an increased risk of cardiovascular adverse events (AEs) but is less effective for improving the QoL in HF patients with preserved EF (HFpEF) populations.

Identifying the Shared Metabolite Biomarkers and Potential Intervention Targets for Multiple Sarcopenia-Related Phenotypes

The relationship between circulating metabolites and sarcopenia-related phenotypes remains unclear. We explored the causality between circulating metabolites and sarcopenia-related phenotypes. Instrumental variables for the human metabolome were derived from the recently published GWAS, which included 690 plasma metabolites. Summary statistics for four sarcopenia phenotypes (whole-body lean mass (WBLM), usual walking pace, appendicular lean mass (ALM), and handgrip strength (HGS)) (both sexes, males and females) were obtained from relevant GWASs. We used MR to evaluate the association between circulating metabolites and sarcopenia-related phenotypes. Colocalization analysis was utilized to determine whether two associated signals were consistent with a shared causal variant rather than the confounding effect of linkage disequilibrium. Subsequently, we explored associations between modifiable risk factors and sarcopenia-related metabolites to explore which metabolites may serve as potential intervention targets through lifestyle modification. Genetically predicted plasma levels of 95 known metabolites were associated with sarcopenia-related phenotypes, and 27 metabolites were supported by robust evidence of colocalization, among which 13 metabolites had a cross-sarcopenia effect. These metabolites primarily included acyl carnitines, amino acids and their derivatives, and phospholipids. Specifically, our analyses supported causal relationships between 23, 6, and 15 metabolites and ALM, HGS, and WBLM, respectively. Seven relevant metabolites might be associated with six modifiable factors. We identified 27 metabolite biomarkers with robust causal evidence for sarcopenia-related phenotypes, highlighting 13 metabolites with a cross-sarcopenia effect, and prioritized several metabolites as the potential interventional targets of lifestyle changes. Our study provided new insight into the etiology and prevention of sarcopenia.

Predictive Value of NT-proBNP, FGF21, Galectin-3 and Copeptin in Advanced Heart Failure in Patients with Preserved and Mildly Reduced Ejection Fraction and Type 2 Diabetes Mellitus

Background and Objectives: Heart failure (HF) is one of the most common initial presentations of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). There are different cardiac biomarkers related to the pathophysiological mechanisms of HF in T2DM. The current research aims to identify additional biomarkers that could improve the diagnosis and prognosis of HFpEF, which is currently assessed using NT pro-BNP levels. NT pro-BNP is a valuable tool for diagnosing heart failure but may not always correlate with clinical symptom severity or can present normal levels in certain cases, such as obesity. Biomarkers like FGF-21 and galectin-3 could provide greater insight into heart failure severity, especially in diabetic patients. The main objective of the current study is to assess the performance of NT-proBNP, FGF21, Galectin-3 and Copeptin to discriminate between advanced and mild HF. Materials and Methods: A total of 117 patients were enrolled in this study and divided into two groups: 67 patients in NYHA functional class I-II (mild HF) and 50 patients in NYHA III-IV (advanced HF). NT-pro BNP, FGF21, Galectin 3 and Copeptin serum levels were determined with the ELISA method. Receiver operating characteristic (ROC) analysis and binomial logistic regression analysis were used to measure the ability of the studied biomarkers to distinguish between advanced and mild HF patients. Results: In patients with T2DM with advanced HF, serum FGF21 level was significantly positively correlated with eGFR (ρ = 0.35, p = 0.0125) and triglycerides (ρ = 0.28, p = 0.0465) and significantly negatively correlated with serum levels of HDL cholesterol (ρ = -0.29, p = 0.0386) and with RV-RA gradient (ρ = -0.30, p = 0.0358). In patients with mild HF, serum FGF21 level was significantly negatively correlated with NT-proBNP levels (ρ = -0.37, p = 0.0022), E/e' ratio (ρ = -0.29, p = 0.0182), TR velocity (ρ = -0.24, p = 0.0470) and RV-RA gradient (ρ = -0.24, p = 0.0472). FGF21 (AUC = 0.70, 95% CI: 0.60-0.79) and NT-proBNP (AUC = 0.73, 95% CI: 0.63-0.82) demonstrated significant predictive value to discriminate T2DM patients with advanced HF from those with mild HF. Elevated values for FGF21 (≥377.50 ng/mL) or NTproBNP (≥2379 pg/mL) were significantly associated with increased odds of advanced HF after adjusting for demographic and clinical covariates. Conclusions: NTpro-BNP and FGF21 have a similar ability to discriminate T2DM patients with advanced HF from those with mild HF. Univariable and multivariable logistic models showed that, FGF21 and NTproBNP were independent predictors for advanced HF in patients with preserved and mildly reduced ejection fraction and T2DM.

Integrated biomarker profiling for enhanced heart failure management: a comprehensive study on the application of chemiluminescence detection of GDF-15 and multi-index models

BACKGROUND

Growth differentiation factor 15 (GDF-15) holds promise as a novel marker for heart failure. However, current detection methods fall short of meeting essential clinical requirements.

OBJECTIVES

The aim of this investigation was to assess the clinical significance of serum GDF-15 detection through the chemiluminescence method and to enhance its clinical application for predicting and evaluating heart failure in patients.

METHODS

A total of 122 patients were included in the study. Serum GDF-15 levels were assessed using the chemiluminescence method and compared with results for NT-proBNP, N-terminal pro-brain natriuretic peptide (NT-proBNP), growth stimulation expressed gene 2 (ST2), high-sensitivity C-reactive protein (hs-CRP), and left ventricular ejection fraction (LVEF). Additionally, we conducted an analysis to evaluate the correlation between these indicators and heart failure events.

RESULTS

LVEF, ST2, NT-proBNP, and GDF-15 exhibited significant associations with heart failure. In the multivariate proportional hazard analysis, subsequent to adjusting for the effects of other markers, however, only LVEF and GDF-15 retained their associations with heart failure events. Notably, GDF-15 emerged as the exclusive marker suitable for diagnosing heart failure with preserved ejection fraction.

CONCLUSION

The chemiluminescence method proved efficient in the rapid and sensitive detection of GDF-15 in patients with heart failure. Additionally, GDF-15 combined with other markers created a robust multi-index model. This model is valuable for heart failure diagnosis, treatment, and monitoring, with broad clinical applicability.

Heart failure misdiagnosed as acute cholecystitis: a case report

BACKGROUND

Heart failure is a clinical syndrome characterized by decreased cardiac output, leading to systemic organ hypoxia and resulting in dyspnea, pulmonary edema, organ congestion, and pleural effusion. Owing to the diverse clinical manifestations of heart failure, early diagnosis can be challenging, and misdiagnosis may occur occasionally. The use of echocardiography and blood brain natriuretic peptide can aid in obtaining a more accurate diagnosis.

CASE PRESENTATION

This article presents two case reports of patients who were misdiagnosed with acute cholecystitis. Both patients were young Mongolia males (age 26 and 39 years) who presented to the emergency department with acute upper abdominal pain, abdominal ultrasound revealed gallbladder enlargement, and blood tests suggested mild elevation of bilirubin levels. However, despite the absence of procalcitonin and C-reactive protein elevation, the patients were admitted to the general surgical department with a diagnosis of "acute cholecystitis." Both patients were given treatment for cholecystitis, but their vital signs did not improve, while later examinations confirmed heart failure. After treatment with diuretics and cardiac glycosides, both patients' symptoms were relieved.

CONCLUSION

We aim to highlight the clinical manifestations of heart failure and differentiate it from rare conditions such as acute cholecystitis. Physicians should make accurate diagnoses on the basis of physical examinations, laboratory testing and imaging, and surveys while avoiding diagnostic heuristics or mindsets. By sharing these two case reports, we hope to increase awareness to prevent potential complications and improve patient outcomes.

Screening of key genes related to M6A methylation in patients with heart failure

OBJECTIVE

This study aims to identify m6A methylation-related and immune cell-related key genes with diagnostic potential for heart failure (HF) by leveraging various bioinformatics techniques.

METHODS

The GSE116250 and GSE141910 datasets were sourced from the Gene Expression Omnibus (GEO) database. Correlation analysis was conducted between differentially expressed genes (DEGs) in HF and control groups, alongside differential m6A regulatory factors, to identify m6A-related DEGs (m6A-DEGs). Subsequently, candidate genes were narrowed down by intersecting key module genes derived from weighted gene co-expression network analysis (WGCNA) with m6A-DEGs. Key genes were then identified through the Least Absolute Shrinkage and Selection Operator (LASSO) analysis. Correlation analyses between key genes and differentially expressed immune cells were performed, followed by the validation of key gene expression levels in public datasets. To ensure clinical applicability, five pairs of blood samples were collected for quantitative real-time fluorescence PCR (qRT-PCR) validation.

RESULTS

A total of 93 m6A-DEGs were identified (|COR| > 0.6, P < 0.05), and five key genes (LACTB2, NAMPT, SCAMP5, HBA1, and PRKAR2A) were selected for further analysis. Correlation analysis revealed that differential immune cells were negatively associated with the expression of LACTB2, NAMPT, and PRKAR2A (P < 0.05), while positively correlated with SCAMP5 and HBA1 (P < 0.05). Subsequent expression validation confirmed significant differences in key gene expression between the HF and control groups, with consistent expression trends observed across both training and validation sets. The expression trends of LACTB2, PRKAR2A, and HBA1 in blood samples from the qRT-PCR assay aligned with the results derived from public databases.

CONCLUSION

This study successfully identified five m6A methylation-related key genes with diagnostic significance, providing a theoretical foundation for further exploration of m6A methylation's molecular mechanisms in HF.

Combined Use of GDF-15 and NT-Pro BNP for Outcome Prediction in Patients with Acute Heart Failure

Background: Acute heart failure (AHF) is characterized by a complex pathophysiology. Aims: This study aimed to evaluate the usefulness of combined serial measurements of N-terminal pro-B-type natriuretic peptide (NT-pro BNP) and growth differentiation factor 15 (GDF-15) for predicting long-term outcomes in patients with AHF. Methods: This study included 104 consecutive patients hospitalized due to AHF. The mean (SD) age was 65 (±15) years. Blood samples were collected on admission, at discharge, and at a 30-day follow-up visit. The primary composite endpoint was all-cause mortality or rehospitalization due to heart failure (HF) at 1-year follow-up. Results: During follow-up, the primary endpoint occurred in 31 persons. In the ROC analysis, the optimal cut-off values of GDF-15 for predicting the outcome were 5115.5 pg/mL on admission, 4145 pg/mL at discharge, and 4218.5 pg/mL at the 30-day visit. For NT-pro BNP, the optimal cut-off reached 6011 ng/L, 1250 ng/L, and 1456.5 ng/L, respectively. Patients with both GDF-15 and NT-pro BNP levels above the cut-off value had a higher risk of the primary composite endpoint than patients with only one or none of the biomarkers elevated at three time points. At the 30-day visit, the model combining NT-pro BNP and GDF-15 showed the highest predictive value for the primary composite endpoint (area under the curve, 0.75). Conclusions: Combined serial measurements of NT-pro BNP and GDF-15 outperform single measurements in outcome prediction at 1-year follow-up in patients with AHF. The repetitive combined model may serve as a useful risk assessment tool and facilitate decision-making during long-term observation.

Emerging methods and techniques for cancer biomarker discovery

Modern cancer research depends heavily on the identification and validation of biomarkers because they provide important information about the diagnosis, prognosis, and response to treatment of the cancer. This review will provide a comprehensive overview of cancer biomarkers, including their development phases and recent breakthroughs in transcriptomics and computational techniques for detecting these biomarkers. Blood-based biomarkers have great potential for non-invasive tumor dynamics and treatment response monitoring. These include circulating tumor DNA, exosomes, and microRNAs. Comprehensive molecular profiles are provided by multi-omic technologies, which combine proteomics, metabolomics, and genomes to support the identification of biomarkers and the targeting of therapeutic interventions. Genetic changes are detected by next-generation sequencing, and patterns of protein expression are found by protein arrays and mass spectrometry. Tumor heterogeneity and clonal evolution can be understood using metabolic profiling and single-cell studies. It is projected that the use of several biomarkers-genetic, protein, mRNA, microRNA, and DNA profiles, among others-will rise, enabling multi-biomarker analysis and improving individualised treatment plans. Biomarker identification and patient outcome prediction are further improved by developments in AI algorithms and imaging techniques. Robust biomarker validation and reproducibility require cooperation between industry, academia, and doctors. Biomarkers can provide individualized care, meet unmet clinical needs, and enhance patient outcomes despite some obstacles. Precision medicine will continue to take shape as scientific research advances and the integration of biomarkers with cutting-edge technologies continues to offer a more promising future for personalized cancer care.