New opportunities for acute decompensated heart failure diagnostics and clinical value of growth factors: VEGF, PDGF-AB, FGF Basic, tissue inhibitor of metalloproteinase-1, and lipoprotein-associated phospholipase A2

In structure of mortality, the leading cause of death of adults in economically developed countries is heart disease with heart failure. Early risk stratification before clinical manifestation of decompensated heart failure is relevant and extremely important task. Aim. The study was aimed at searching for new diagnostic biomarkers and predictors of high risk of adverse cardiovascular events and mortality in patients with decompensated heart failure. A total of 206 patients, enrolled in the study, were assigned into 3 groups: group 1 comprised 94 patients with postmyocardial infarction or ischemic remodeling where the prognostic importance of growth factors of VEGf, PDGF-AB, and FGF basic was studied; the diagnostic importance of TIMP-1 was studied in 52 patients with HF NYHA classes II- IV (group 2); and the predictive value of Lp-FLA2 was analyzed in 60 patients with diabetes mellitus type 2 associated with HF NYHA class II (group 3). Receiver operating characteristic (ROC) curves used for assessing the accuracy of predictions revealed high positive predictive values for growth factors VEGF (the area under a curve 0.71+0.05; r=0.000) and FGF basic (0.71+0.05; r=0.000), for PDGF-AB (0.66+0.06; r=0.009). Plasma level of TIMP-1>485.7 ng/mL was found to be an independent, highly sensitive prognostic factor of progression of HF and mortality (specificity of 100%; sensitivity of 80.4%). We found high correlation (r=0.66; p=0.000) between concentration of Lp-FLA2 and a frequency of a stenosis of coronary arteries in patients with type 2 diabetes mellitus (cutoff level of Lp-FLA2 983 ng/mL, sensitivity of 80%; specificity of 100%). Prognostic value of TIMP-1 as an independent marker of risk for progressing of HF and mortality is great and it should be used more widely in cardiology practice. Our study suggests that the levels of growth factors and Lp-FLA2 can be used as candidate markers associated with ischemic dysfunction of the heart, atherosclerosis of coronary arteries, and metabolic disorders. Larger studies are required to verify these findings.