New Biomarkers in the Prognostic Assessment of Acute Heart Failure with Reduced Ejection Fraction: Beyond Natriuretic Peptides

Natriuretic peptides are established biomarkers related to the prognosis of heart failure.New biomarkers have emerged in the area of cardiovascular disease. The prognostic value of these biomarkers in heart failure with reduced LVEF (HFrEF) is not well established.We conducted a prospective, single-centre study, including consecutively (July 2019 to March 2023) 104 patients admitted with a diagnosis of acute HFrEF decompensation.Median follow-up was 23.5 months, during which 20 deaths (19.4%) and 21 readmissions for heart failure (20.2%) were recorded. Plasma biomarkers such as NT-proBNP, GDF-15, sST2, uPAR, and FGF-23 were associated with an increased risk of all-cause mortality. However, a Cox regressionanalysis showed that the strongest predictors of mortality were estimated glomerular filtration rate (HR 0.96 [0.93-0.98]), GDF-15 (HR 1.3 [1.16-1.45]), and sST2 (HR 1.2 [1.11-1.35]). The strongest predictive model was formed by the combination of glomerular filtration rate and sST2 (C-index 0.758). In conclusion, in patients with acute decompensated HFrEF, GDF-15 and sST2 showed the highest predictive power for all-cause mortality, superior to other established biomarkers such as natriuretic peptides. GDF-15 and sST2 may provide additional prognostic information to improve the prognostic assessment.