Biomarkers distinguish HFrEF and HFpEF

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  • Participants in a set of 4 cohorts show different biomarker profiles associated with heart failure (HF) with reduced or preserved ejection fraction (HFrEF, HFpEF, respectively).
  • The usual natriuretic peptides (NPs) and urinary albumin-creatinine ratio (UACR) characterized HFpEF, whereas HFrEF was also associated with high-sensitivity troponin, inflammation, and neurohormonal activation. 
  • Adding biomarkers improved risk estimates somewhat and discriminated HFrEF a little better than HFpEF.

Why this matters

  • Despite the existence of at least 2 HF subtypes, biomarker profiles that distinguish them remain to be established.
  • These authors say the results point to the need for more focus on biomarker studies, especially for HFpEF.

 Study design

  • Study evaluated 22,756 participants from 4 longitudinal community-based cohorts.
  • Funding: National Heart, Lung, and Blood Institute.

Key results

  • UACR (subdistribution aHR [saHR], 1.33; P<.001) and NPs (saHR, 1.27; P<.001) were associated with HFpEF risk.
  • NP (saHR, 1.54; P<.001), UACR (saHR, 1.21; P<.001), high-sensitivity troponin (saHR, 1.37; P<.001), cystatin C (saHR, 1.19; P<.001), D-dimer (saHR, 1.22; P<.001), and C-reactive protein (saHR, 1.19; P<.001) were associated with HFrEF.
  • C-statistic for HFrEF improved with addition of NP (+0.022; P<.001) and high-sensitivity troponin (+0.021; P<.001).
  • For HFpEF, improvement was smaller, with the largest for UACR (+0.010; P=.03).


  • Not all biomarkers were available in each cohort.

Coauthored with Antara Ghosh, PhD