Heart Failure with Preserved Ejection Fraction in the Elderly: Conventional and Emerging Prognostic Biomarkers in Daily Clinical Practice

Abstract

Purpose: Albumin serum levels and N-terminal brain natriuretic peptide (NT proBNP) have shown to be useful in predicting outcome in patients with heart failure and systolic dysfunction. Carbohydrate antigen 125 (CA 125) has also been associated to a higher risk of mortality and rehospitalization in patients with HF and reduced left ventricular systolic function. The role of these biomarkers for stratifying prognosis in patients with HF and preserved ejection fraction (PEF) is not so well established. The aim of this study was to evaluate the prognostic role of these biomarkers among acute decompensated HF PEF patients. METHODS Data were collected prospectively from 221 consecutive patients with HF admitted to a secondary hospital from 2011 to 2012. Patients with advanced chronic renal disease, high output HF, history of a congenital heart disease, patients with mitral or aortic prosthesis, severe mitral or aortic native valve disease, and patients with a LVEF<50% were excluded. All patients were followed during one year after discharge. RESULTS Finally, 154 patients with HF PEF were enrolled. The average age was 81 years (SD 9). 63 % were female. During follow-up, 37 patients died (mortality rate: 24%). The cause of dead could be ascertained in 25 of these 37 subjects. Median plasma concentration of NT proBNP at baseline was 1965 ng/l, (IQR 4016). In a multivariable analysis, NT proBNP, higher than the median (OR 5,36; 1. 84-15.65, CI 95%, p=0,002) was associated with an increased risk of mortality. Average serum albumin value was 3,7 (SD 0,4) g/dl. Hypoalbuminaemia was defined as a plasmatic concentration <3.5 g/dl. No association was found between albuminaemia and advances stages of liver disease or malnutrition. Hypoalbuminaemia was associated to a higher risk of death (RR 2.57, 1.46-4.52 CI 95%, p=0,001). The median plasma concentration of CA 125 at baseline was 28.9 U/ml (IQR: 65.2). No gender differences were found. There was no significant association between a previous history of autoimmune disease or malignancy and CA 125 concentrations. Increased CA 125 levels were related to congestive radiologic signs, such as pleural effusion. (p=0.001). CA 125 > 31 U/ml was related to a significant increase risk of death (RR 4.72, 95% CI 1.09-20.37; p=0.017) in male patients, but not among women. CA 125 >31.4 U/ml was also indentified as an independent predictor of mortality among octogenarians (OR 4.32, 95% IC 1.10-16,94; p=0,036). CONCLUSION NT proBNP, albuminaemia, and CA 125 could be used as filtering tools to select those cases with the highest clinical risk among hospitalized HF PEF patients.