Diagnostics and prognostic potential of current biomarkers in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Abstract

Aims Circulating biomarkers are commonly used in diagnosis and prognosis of heart failure with preserved ejection fraction (HFpEF) in clinical practice. However, the diagnostic and prognostic potential of current biomarkers in HFpEF remain unclear. Methods and results We conducted a search of the PubMed, Web of Science, MEDLINE and SCOPUS (1900 to January 2020) databases of all diagnostic (n=1,104) and prognostic (n=53,497) biomarkers investigated in people with HFpEF. B-type natriuretic peptide (BNP) displayed satisfactory sensitivity (0.81, 95% CI: 0.76 to 0.85; I2=0) and specificity (0.86, 95% CI: 0.82 to 0.89; I2=16.9%) for the diagnosis of HFpEF. Natriuretic peptides (NPs), including N-terminal pro BNP (NT-proBNP) and BNP, were associated with over two-fold increased risk of mortality (NT-proBNP: HR=2.27, 95% CI: 1.69 to 3.06, I2=87.6%; BNP: HR=3.01, 95% CI: 1.27 to 7.21, I2=97.2%), hospitalisation (NT-proBNP: HR=3.54, 95% CI: 2.83 to 4.43, I2=83.4%), and a composite event of both (NT-proBNP: HR=2.55, 95% CI: 2.13 to 3.05, I2=78.1%; BNP: HR=2.28, 95% CI: 1.42 to 3.69, I2=75.8%) in people with HFpEF. Interestingly, Galectin-3 (Gal-3) (sensitivity: 0.70, 95% CI: 0.63 to 0.75, I2=86.7%; specificity: 0.78, 95% CI: 0.69 to 0.85, I2=68.6%) and soluble suppression of tumorigenicity 2 (sST2) (sensitivity: 0.58, 95% CI: 0.52 to 0.64, I2=88.1%; specificity: 0.59, 95% CI: 0.49 to 0.68, I2=69.5%) showed limited diagnostic potential of HFpEF. Conclusion Amongst currently available biomarkers, BNP remains the most reliable diagnostic marker of HFpEF. Although there was high heterogeneity between the studies included, BNP or NT-proBNP could also have promising prognostic potential in HFpEF.

Diagnostic Performance of Serum Biomarkers Fibroblast Growth Factor 21, Galectin-3 and Copeptin for Heart Failure with Preserved Ejection Fraction in a Sample of Patients with Type 2 Diabetes Mellitus

“…Patients with HFpEF represent nearly 50% of the HF population and is associated with a decreased life expectancy [ 26 , 28 ]. This impaired prognosis, however, is not fully explained by the associated comorbidities such as hypertension, diabetes mellitus, atrial fibrillation and obesity, as higher mortality rates have been reported in patients with HFpEF than in those with similar comorbidities but without HF [ 28 ]. Regarding NT-ProBNP, which has a high specificity but a lower sensitivity for the diagnosis of HFpEF, new biomarkers need to be investigated.…”

“…A systematic review and meta-analysis [ 24 ] which investigated the diagnostic potential of biomarkers in HFpEF found that the studies investigating galectin-3 as a diagnostic biomarker of HFpEF were conducted in Asia, with cut-off values of 9.55 ng/mL, 17.8 ng/mL, 20.12 ng/mL [ 28 , 38 , 39 , 40 ].…”

Mean Levels of B-type Natriuretic Peptide (BNP) in Patients with Mitral Stenosis Caused by Rheumatic Heart Disease

“…N-terminal pro-BNP releases in response to chronically increased pressure in the ventricles such as in ventricular dysfunction or heart failure. Its role in heart failure is well defined [14][15][16] but its direct association in patients with mitral stenosis is not well defined in the presence of normal left ventricular function (LV). The release of BNP in patients with mitral stenosis with normal LV function is probably the result of volume and pressure overload particularly when the disease is of moderate to severe intensity that is why its significance is not well studied yet.…”