Erythroferrone can Diagnose Acute Decompensated Heart Failure in Patients Presenting With Breathlessness

Abstract

Comorbidities are a major concern for heart failure (HF) patients as they lead to adverse outcomes and increased mortality rates. Circulating levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) are clinically mandated in the diagnosis of HF, but levels can be altered by co-morbidities such as atrial fibrillation (AF) and obesity. Thus, complementary biomarkers not influenced by these comorbidities are needed. Here we provide the first report on the performance of a novel biomarker, erythroferrone, in the diagnosis of acute decompensated HF (ADHF). The diagnostic potential of erythroferrone was determined in patients (n=479) presenting to the Christchurch emergency department with dyspnoea. Erythroferrone (ELISA, Intrinsic Lifesciences) and NT-proBNP (Roche Cobas e411) were measured in EDTA plasma by immunoassay. Ability to diagnose ADHF was assessed using areas under (AUC) receiver operator curves and binary logistic models with adjustment for conventional clinical risk factors. Plasma erythroferrone levels were significantly elevated in ADHF compared to all other diagnoses (4.9 vs 1.4 ng/mL, n=171, p<0.001). Logistic regression revealed erythroferrone to be a significant independent predictor of ADHF (p=0.001), although it was outperformed by NT-proBNP (p<0.001). Erythroferrone (ERFE) appeared to be slightly better at diagnosing ADHF than NT-proBNP in obese patients (BMI ≥30 kg/m2, AUC 0.91 vs 0.90, respectively, n=53) and those with AF (AUC 0.80 vs 0.77, n=64), although sample numbers preclude formal comparisons. Diagnosis of ADHF in patients with comorbidities could be enhanced using erythroferrone, either on its own or in combination with NT-proBNP. These preliminary Results warrant further investigation in larger cohorts.