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Arch Med Sci. 2018 Jun;14(4):890-909. doi: 10.5114/aoms.2018.76279. Epub 2018 Jun 11.

Biomarkers, myocardial fibrosis and co-morbidities in heart failure with preserved ejection fraction: an overview.

Author information

1
Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.
2
Department of Endocrine Disorders and Bone Metabolism, 1 Chair of Endocrinology, Medical University of Lodz, Lodz, Poland.
3
Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
4
Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
5
Division of Cardiology and Metabolism - Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
6
Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.
7
Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.

Abstract

The prevalence of heart failure with preserved ejection fraction (HFpEF) is steadily increasing. Its diagnosis remains difficult and controversial and relies mostly on non-invasive echocardiographic detection of left ventricular diastolic dysfunction and elevated filling pressures. The large phenotypic heterogeneity of HFpEF from pathophysiologic al underpinnings to clinical manifestations presents a major obstacle to the development of new therapies targeted towards specific HF phenotypes. Recent studies suggest that natriuretic peptides have the potential to improve the diagnosis of early HFpEF, but they still have significant limitations, and the cut-off points for diagnosis and prognosis in HFpEF remain open to debate. The purpose of this review is to present potential targets of intervention in patients with HFpEF, starting with myocardial fibrosis and methods of its detection. In addition, co-morbidities are discussed as a means to treat HFpEF according to cut-points of biomarkers that are different from usual. Biomarkers and approaches to co-morbidities may be able to tailor therapies according to patients' pathophysiological needs. Recently, soluble source of tumorigenicity 2 (sST2), growth differentiation factor 15 (GDF-15), galectin-3, and other cardiac markers have emerged, but evidence from large cohorts is still lacking. Furthermore, the field of miRNA is a very promising area of research, and further exploration of miRNA may offer diagnostic and prognostic applications and insight into the pathology, pointing to new phenotype-specific therapeutic targets.

KEYWORDS:

Introduction; biomarkers; diagnosis; heart failure with preserved ejection fraction; microRNA

Conflict of interest statement

MMK, AGB, and MB have not received any payments in connection with the preparation of this review. SvH has been a paid consultant to Roche, BRAHMS/Thermo Fisher Scientific, Vifor, and Bayer. He has received speaker’s fees from Boehringer Ingelheim, Novartis, and Amgen. No medical or pharmaceutical company was involved in the preparation of this article.

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