Pro-inflammatory biomarkers in stable versus acutely decompensated heart failure with preserved ejection fraction

Abraham Abernethy, Sadi Raza, Jie Lena Sun, Kevin J. Anstrom, Russell Tracy, Johannes Steiner, Peter VanBuren, Martin M. LeWinter

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Background--Underlying inflammation has been increasingly recognized in heart failure with a preserved ejection fraction (HFpEF). In this study we tested the hypothesis that pro-inflammatory biomarkers are elevated in patients with acutely decompensated HFpEF (AD-HFpEF) compared with patients with stable HFpEF (S-HFpEF). Methods and Results--Using a post hoc analysis the serum biomarkers tumor necrosis factor-alpha, high-sensitivity C-reactive protein interleukin 6 and pentraxin 3 (PTX3) and clinical, demographic, echocardiographic-Doppler and clinical outcomes data were analyzed in HFpEF patients enrolled in NHLBI Heart Failure Research Network clinical trials which enrolled patients with either AD-HFpEF or S-HFpEF. Compared to S-HFpEF, AD-HFpEF patients had higher levels of PTX3 (3.08 ng/mL versus 1.27 ng/mL, P < 0.0001), interleukin-6 (4.14 pg/mL versus 1.71 pg/mL, P < 0.0001), tumor necrosis factor-alpha (11.54 pg/mL versus 8.62 pg/mL, P=0.0015), and high-sensitivity C-reactive protein (11.90 mg/dL versus 3.42 mg/dL, P < 0.0001). Moreover, highsensitivity C-reactive protein, interleukin-6 and PTX3 levels were significantly higher in AD-HFpEF compared with S-HFpEF patients admitted for decompensated HF within the previous year. PTX3 was positively correlated with left atrial volume index (r=0.41, P=0.0017) and left ventricular mass (r=0.26, P=0.0415), while tumor necrosis factor-alpha was inversely correlated with E/A ratio (r=-0.31, P=0.0395). Conclusions--Levels of pro-inflammatory biomarkers are strikingly higher in AD-HFpEF compared with S-HFpEF patients. PTX3 and tumor necrosis factor-alpha are correlated with echocardiographic-Doppler evidence of diastolic dysfunction. Taken together these data support the concept that a heightened pro-inflammatory state has a pathophysiologic role in the development of AD-HFpEF.

Original languageEnglish (US)
Article numbere007385
JournalJournal of the American Heart Association
Issue number8
StatePublished - Apr 17 2018
Externally publishedYes


  • Biomarker
  • Decompensated heart failure
  • Diastolic dysfunction
  • Diastolic heart failure
  • Ejection fraction
  • Heart failure
  • Pro-inflammatory biomarkers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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