Biomarkers in acutely decompensated heart failure with preserved or reduced ejection fraction

Am Heart J. 2012 Nov;164(5):763-770.e3. doi: 10.1016/j.ahj.2012.08.014. Epub 2012 Oct 16.


Background: Acute decompensated heart failure (ADHF) occurs with preserved (heart failure with preserved ejection fraction [HFpEF] ≥50%) or reduced (heart failure with reduced ejection fraction [HFrEF] <50%) ejection fraction. Natriuretic peptide (NP) levels are lower in HFpEF than HFrEF. We hypothesized that lower NP levels in HFpEF may be associated with other differences in biomarkers, specifically, renin-angiotensin-aldosterone system (RAAS) activation, oxidative stress, and a biomarker that reflects collagen synthesis.

Methods: In this prespecified ancillary analysis of patients with ADHF enrolled in the Diuretic Optimization Strategies Evaluation study, clinical features and N-terminal pro-B-type NP, cystatin C, plasma renin activity, aldosterone, oxidative stress (uric acid), and procollagen type III N-terminal peptide were compared in HFpEF and HFrEF at enrollment and 60-day follow-up.

Results: Compared with HFrEF (n = 219), HFpEF (n = 81) patients were older, heavier, more commonly female, less treated with RAAS antagonists, but with similar New York Heart Association class, jugular venous pressure, and edema severity. N-terminal pro-B-type NP was lower, and systolic blood pressure and cystatin C were higher in HFpEF. Despite higher systolic blood pressure and less RAAS antagonist use in HFpEF, plasma renin activity and aldosterone levels were similar in HFpEF and HFrEF as were uric acid and procollagen type III N-terminal peptide levels. Changes in biomarker levels from enrollment to 60 days were similar between HFrEF (n = 149) and HFpEF (n = 50).

Conclusion: Lower NP levels in decompensated HFpEF occur in association with similar ADHF severity, more impaired vascular and renal function but similar elevation of biomarkers that reflect RAAS activation, oxidative stress, and collagen synthesis as in HFrEF.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aldosterone / blood
  • Biomarkers / blood*
  • Blood Pressure
  • Cystatin C / blood
  • Diuretics / administration & dosage*
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Heart Failure / blood*
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Natriuretic Peptides / blood*
  • Oxidative Stress / drug effects
  • Peptide Fragments / blood
  • Predictive Value of Tests
  • Procollagen / blood
  • Prospective Studies
  • Renin / blood
  • Renin-Angiotensin System* / drug effects
  • Severity of Illness Index
  • Stroke Volume*
  • Uric Acid / blood


  • Biomarkers
  • Cystatin C
  • Diuretics
  • Natriuretic Peptides
  • Peptide Fragments
  • Procollagen
  • pro-brain natriuretic peptide (1-76)
  • procollagen Type III-N-terminal peptide
  • Natriuretic Peptide, Brain
  • Uric Acid
  • Aldosterone
  • Renin