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Heart Failure with Preserved Ejection Fraction and Coronary Artery Disease subphenotype: mortality and biomarkers profiles analysis
Session:
Posters (Sessão 4 - Écran 2) - Insuficiência cardíaca - estratificação de risco
Speaker:
Marta Catarina Almeida
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Marta Catarina Almeida; André Lobo; Rafael Teixeira; Diogo Santos-Ferreira; Francisco Sampaio; José Ribeiro; Francisca Saraiva; Sílvia Diaz; António Barros; Adelino F. Leite-Moreira; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent and heterogeneous entity. Coronary artery disease (CAD) is a common comorbidity associated with HFpEF and a known worse prognosis. The importance of biomarkers’ profile in HFpEF patients associated with CAD has not yet been explored. This study aims to identify differencial biomarkers profiles in HFpEF patients with or without CAD and the association with clinical outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods:</span></strong><span style="font-family:"Arial",sans-serif"> Metabolic Road to Diastolic Heart Failure (MEDIA-DHF) prospective international cohort of 392 patients with HFpEF submitted to clinical and phenotypic characterization was used. A total of 412 plasma biomarkers were analyzed using Olink Proseek Multiplex panels. CAD vs. non-CAD groups were compared through Wilcoxon, Chi-square, t-tests and ANCOVA, as appropriate. Survival analysis was performed for the composite endpoint of cardiovascular (CV) death and/or hospitalization up to 1-year follow-up. Cox proportional hazard regression model was used to assess biomarkers impact adjusted for sex, diabetes, smoking history, LDL cholesterol, beta-blockers, antiplatelet agents, and statins.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">The 128 patients with CAD were more frequently man, had more diabetes, smoking habits, blood lipid disorders, peripheral artery disease and sleep apnea. CAD patients were more likely to be treated with beta-blockers, loop diuretics, non-dihydropyridine and antiplatelet agents, sulfonylureas, insulin, and statins. The outcome of CV death and/or hospitalization occurred in 28 of 128 patients with CAD (22%) vs. 32 in 252 patients without (13%) (Log Rank test p = 0.018). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">We observed 18 biomarkers different between groups after adjustment, mainly related to cellular metabolism, cell adhesion, immune response and complement activation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Arial",sans-serif">We identified 42 biomarkers associated with the outcome, distinct from the previous ones, and most of them were related to cell interactions and signaling cascade. The biomarkers with higher effect size were <em>TNF-related apoptosis-inducing ligand receptor 2, C-C motif chemokine 20, NT-proBNP, FGF23, Protein FosB and Kidney Injury Molecule</em>. <em>Gastric intrinsic factor</em>, <em>Liver carboxylesterase 1 </em>and <em>Coagulation factor 7</em> were more expressed in patients without the outcome. </span></span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"> CAD was associated with a worse prognosis in patients with HFpEF. However, biomarkers associated with the outcome were not those associated with the presence of CAD. Understanding these mechanisms could help unravel specific unknown pathways and therapeutic strategies to improve the management of HFpEF.</span></span></p>
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