Clinical InvestigationCongestive Heart FailureBiomarkers in acutely decompensated heart failure with preserved or reduced ejection fraction
Section snippets
Methods
The DOSE study was a prospective, randomized, double-blind, controlled trial conducted by the Heart Failure Clinical Research Network (HFCRN) examining responses to different diuretic intensification (1.0 and 2.5 times outpatient dose) and administration (intravenous bolus or continuous infusion) strategies. The data coordinating center (Duke Clinical Research Institute) was responsible for data management and statistical analysis. The study was approved by the institutional review board at
Clinical characteristics in HFrEF and HFpEF with ADHF
A total of 308 patients were enrolled in the DOSE trial. Left ventricular ejection fraction (LVEF) assessment within 1 year (median of 1.3 months, IQR of 0 to 5.9 months) was available in 300 patients (echocardiogram [n = 287], radionuclide [n = 3] or contrast ventriculogram [n = 6], or other [n = 4]) (Table I). There were 219 patients (73%) with HFrEF (median LVEF 24%, IQR 20%-32%) and 81 patients (27%) with HFpEF (median LVEF 57%, IQR 55%-64%). Consistent with previous reports, HFpEF patients
Discussion
In this well-characterized, prospectively enrolled cohort of patients with ADHF, NT-proBNP levels were lower in HFpEF than HFrEF despite similar severity of ADHF. Heart failure with preserved ejection fraction was characterized by higher systolic blood pressure, more severe renal dysfunction but similar biomarkers of RAAS activation, and oxidative stress as well as the serum peptide, PIIINP, which reflects collagen synthesis. Furthermore, changes in all biomarkers at follow-up were
Limitations
Assessment of biomarkers was carried out at enrollment and administration of diuretics before enrollment may have influenced our findings. The DOSE trial did not mandate EF measurement during the hospitalization. However, the median time since EF evaluation was 1.3 months, and the characteristics of HFpEF patients were similar to those described in other studies. The smaller number of subjects with paired data at 60 days limited power to detect differences and patients who were sicker may not
Conclusion
In this contemporary, prospectively enrolled cohort of patients with ADHF, patients with HFpEF had similar HF severity as patients with HFrEF. However, as compared with HFrEF, HFpEF patients had lower NT-proBNP; higher systolic blood pressure; and more severe renal dysfunction with similar levels of RAAS activation, oxidative stress, and a marker that reflects collagen synthesis. These findings underscore the importance of similarly altered biomarkers of neurohumoral activation, oxidative
Disclosures
The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.
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Jerome L. Fleg, MD, Clin. Inv., CHF served as guest editor for this article.
Funding sources: The HFCRN is supported by grants HL084861, HL084875, HL084877, HL084889, HL084890, HL084891, HL084899, HL084904, HL084907, and HL084931. K.B. is supported by HL07111-83, whereas support for mentoring K.B. as a HFCRN Skills Development fellow is provided by HL084907 and UL1 RR024150.