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Soluble Urokinase Plasminogen Activator Receptor Levels and Outcomes in Patients with Heart Failure

Published:September 16, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.08.010

      Abstract

      Background

      Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and pathogenic factor for kidney disease shown to predict cardiovascular outcomes including heart failure (HF) in various populations. We characterized suPAR levels in patients with HF and compared its ability to discriminate risk to that of B-type natriuretic peptide (BNP).

      Methods and Results

      We measured plasma suPAR and BNP levels in 3,437 patients undergoing coronary angiogram and followed for a median of 6.2 years. We performed survival analyses for the following outcomes: all-cause death, cardiovascular death, and hospitalization for HF. We then assessed suPAR's ability to discriminate risk for the aforementioned outcomes. We identified 1116 patients with HF (age 65±12, 67.2% male, 20.0% Black, 67% with reduced ejection fraction). The median suPAR level was higher in HF compared to those without HF (3370 [IQR 2610-4371] vs. 2880 [IQR 2270-3670] pg/mL, respectively, P<0.001). In patients with HF, suPAR levels (log-base 2) were associated with outcomes including all-cause death (adjusted hazard ratio aHR 2.30, 95%CI[1.90-2.77]), cardiovascular death (aHR 2.33 95%CI[1.81-2.99]) and HF hospitalization (aHR 1.96, 95%CI[1.06-1.25]) independently of clinical characteristics and BNP levels. The association persisted across subgroups and did not differ between patients with reduced or preserved ejection fraction, or those with ischemic or non-ischemic cardiomyopathy. Addition of suPAR to a model including BNP levels significantly improved the C-statistic for death (Δ0.027), cardiovascular death (Δ0.017) and hospitalization for HF (Δ0.017).

      Conclusions

      SuPAR levels are higher in HF compared to non-HF, are strongly predictive of outcomes, and combined with BNP, significantly improved risk prediction.

      Lay Summary

      • Soluble urokinase plasminogen activator receptor (suPAR) is a circulating protein of immune origin notorious for its involvement in kidney disease, and which levels have been found to predict the onset of heart failure.
      • Given the pathophysiologic link between heart failure and kidney disease, we sought to examine suPAR levels in patients with heart failure.
      • We measured suPAR in 1116 patients with heart failure, and found that levels were strongly predictive of outcomes independently of risk factors and above and beyond the myocardial marker BNP. SuPAR level may be useful as an adjunctive measure for risk stratification of patients with heart failure.

      Key Words

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      Linked Article

      • New Biomarkers in Heart Failure: The Bar is High
        Journal of Cardiac Failure
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          Soluble urokinase plasminogen activator receptor (suPAR) is the circulating form of uPAR, a glycosyl-phosphatidylinositol-anchored 3-domain receptor protein expressed on immune cells, and correlates with inflammatory states.1 Increased suPAR levels are associated with the progression of chronic kidney disease and cardiovascular disease (CVD), and are especially associated with poor outcomes in various disease states, including cardiovascular disease, HIV, chronic kidney disease, and critical illness.
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