# Differences in Scalp Hair Trace Element Concentrations in Patients with Preserved Left Ventricular Ejection Fraction (HFpEF) Compared with Controls: A Hypothesis-Generating Study

## TL;DR

This study found higher levels of certain trace elements in the scalp hair of patients with heart failure with preserved ejection fraction compared to controls.

## Contribution

The study explores trace element differences in HFpEF patients through scalp hair analysis, generating hypotheses for further research.

## Key findings

- HFpEF patients had higher hair concentrations of magnesium, copper, calcium, and lead compared to controls.
- The findings suggest a potential link between trace element imbalances and HFpEF pathophysiology.
- The study is hypothesis-generating and calls for larger studies with additional biological measurements.

## Abstract

Background: The pathophysiology of HFpEF is complex and characterized by systemic inflammation, metabolic dysregulation, and endothelial dysfunction. Trace element involvement in redox balance, mitochondrial function, and calcium signaling is postulated. This cross-sectional analysis aimed to investigate possible differences in hair scalp trace element concentrations in patients with HFpEF and controls. Material and methods: Fifty-eight consecutive patients were enrolled (HFpEF n = 37; controls n = 21). HFpEF diagnosis was established using the HFA-PEFF diagnostic algorithm by two independent cardiologists blinded to hair analysis results. Scalp hair samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Results: HFpEF patients demonstrated higher hair concentrations of magnesium (17.8 (7.3–47.5) vs. 14.0 (6.7–29.0) µg/g, p = 0.037), copper (57.24 (33.87–84.76) vs. 12.96 (9.85–26.02) µg/g, p < 0.001), calcium (322 (106–1330) vs. 145 (74–672) µg/g, p = 0.006), and lead (0.257 (0.164–0.563) vs. 0.159 (0.079–0.283) µg/g, p = 0.03). Conclusions: In this exploratory analysis, HFpEF was associated with differences in selected scalp hair trace element concentrations. The interaction between magnesium, calcium, copper, and lead were noted, with higher concentrations in HFpEF phenotypes. These findings are hypothesis-generating and warrant confirmation in larger cohorts incorporating serum/urine measurements and exposure assessment.