034| Volume 26, ISSUE 10, SUPPLEMENT , S15-S16, October 2020

Elevated Serum Endothelial Glycocalyx Is Associated with Decreased Survival in Patients with Heart Failure with Reduced Ejection Fraction


      Endothelial glycocalyx (eGC) contains proteoglycan polymers, such as syndecan-1, heparan sulfate (HS), and hyaluronic acid (HA), which play an important role in protecting endothelial cells from inflammatory cells and cytokines, as well as regulating intravascular volume. Disruption of eGC has been shown to be associated with heart failure (HF), but the prognostic role of serum syndecan-1, heparan sulfate, and hyaluronic acid remain to be elucidated.


      Increased serum syndecan-1, HS, and HA may be associated with decreased survival in patients with HF with reduced ejection fraction (HFrEF).


      Healthy controls, HFrEF patients presented with acute decompensated HF (ADHF), and chronic HF (CHF) were recruited from three separate ongoing cohorts at the Cleveland Clinic. Whole blood was collected from each subject at the day of enrollment. Primary endpoint is accumulated survival.


      51 healthy controls and 138 patients with HFrEF (66 ADHF patients and 72 CHF patients) were prospectively enrolled. During the follow-up time of 557±363 days, 12 (18.2%) ADHF and 9 (12.5%) CHF patients died. Serum syndecan was significantly elevated in ADHF compared to patients with CHF and healthy controls (101.4±77.3 vs 53.5±65.6 and 35.7±54.2 ng/mL, respectively, p =0.001), as well as serum HS (9806±23943, 4075±4243, and 2182±1187 ng/mL, respectively, p =0.011), and HA (75.9±76.2, 49.4±50.8, and 37.3±27.4 ng/mL, respectively, p = 0.001). In HF patients, serum elevated serum syndecan-1 and HS (above median, 43.56 and 3384.5 ng/mL, respectively) were associated with decreased accumulated survival (log rank p = 0.007, and 0.016, respectively) (Figure). However, elevated serum HA was not associated with survival (log rank p = 0.257). In multivariate cox regression analysis adjusting for gender, BMI, and systolic blood pressure, only heparan sulfate was independently associate with all-cause mortality (hazard ratio per doubling 1.315, 95% confidence interval 1.012-1.709, p = 0.040).


      Serum eGC was substantially increased in patients with ADHF, and elevated serum syndecan-1 and HS were associated with decreased survival in patients with HFrEF.
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