Abstract
BackgroundBiomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF.Methods and ResultsUrine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFrEF patients and 29 age- and sex-matched individuals without HFrEF resulted in identification of 103 peptides that were significantly differentially excreted in HFrEF. These 103 peptides were used to establish the support vector machine-based HFrEF classifier HFrEF103. In a subsequent validation cohort, HFrEF103 very accurately (area under the curve, AUC = 0.972) discriminated between HFrEF patients (N = 94, sensitivity = 93.6%) and control individuals with and without impaired renal function and hypertension (N = 552, specificity = 92.9%). Interestingly, HFrEF103 showed low sensitivity (12.6%) in individuals with diastolic left ventricular dysfunction (N = 176). The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin.ConclusionCE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure.
Highlights
Heart failure is a complex clinical syndrome characterized by impaired ventricular filling and/ or ejection of blood resulting in the disability of the heart to pump a sufficient amount of blood to meet the metabolic demands of the body
Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles
CE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of heart failure with reduced ejection fraction (HFrEF)-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure
Summary
Heart failure is a complex clinical syndrome characterized by impaired ventricular filling and/ or ejection of blood resulting in the disability of the heart to pump a sufficient amount of blood to meet the metabolic demands of the body. Prognostication and follow-up of HFrEF patients based on currently utilized clinical, laboratory and imaging markers in the everyday practice is often complex [3,4]. Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF
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