# Circulating Biomarkers in Elderly Patients with Heart Failure: A Real-Life Study

## TL;DR

This study shows that optimizing drug therapy in elderly heart failure patients improves multiple biomarkers linked to heart health and inflammation.

## Contribution

The study provides real-life evidence of biomarker improvements in elderly patients with improved heart failure ejection fraction after therapy optimization.

## Key findings

- Significant improvements in glycometabolic, renal, and inflammatory profiles were observed after six months.
- Proteomic analysis identified changes in key cardiovascular proteins like IBP4, TSP4, ICAM1, and SDC4.
- Therapy optimization showed comprehensive effects on inflammation, oxidative stress, and thrombotic risk.

## Abstract

Background: Heart failure (HF) is a clinical syndrome that involves multiple interconnected pathways. Circulating biomarkers in HF emerged as powerful tools for risk stratification, diagnostic confirmation, prognostic assessment, and monitoring of treatment efficacy. The aim of the present study was to evaluate circulating levels of biomarkers in elderly patients with improved HF ejection fraction, previously with left ventricular ejection fraction (LVEF) <40%, after six months of drug therapy optimisation. Methods: We enrolled 100 HFimpEF outpatients. All patients provided medical history and underwent physical examination at baseline and after six months of follow-up. The serum values of circulating biomarkers were assessed with an ELISA test. Proteomic analysis was performed on serum samples collected from a subset of 13 patients at baseline and after six months of follow-up. Results: At follow-up, we observed significant improvements in glycometabolic, renal and inflammatory profiles (p < 0.001). Proteomic analysis revealed selective changes in key cardiovascular (CV)-related proteins, such as insulin-like growth factor-binding protein 4 (IBP4), thrombospondin-4 (TSP4), intercellular adhesion molecule 1 (ICAM1), and syndecan-4 (SDC4). Conclusions: This study demonstrates significant improvements across multiple CV biomarkers after six months of therapy optimisation in HFimpEF patients, providing evidence for comprehensive therapeutic effects targeting inflammation, oxidative stress, neurohormonal activation, and thrombotic risk.