Alexander E Berezin
The prevalence of heart failure with preserved left ventricular ejection fraction (HFpEF) rises consequently within past decades. Both phenotypes of HF, i.e. HFpEF and HF with reduced EF (HFrEF), have exhibited similar cardiovascular mortality rates and admission rates, while development and progression of HFpEF and HFrEF associate with different co-morbidities. Understanding of the pathophysiological mechanisms of the two phenotypes of HF is essential for discovery of future new treatments. Biomarkers reflecting several stages of failing heart evolution and different pathophysiological faces of HF (N-terminal pro brain natriuretic peptide, high-sensitivity troponin T, and galectin-3) have been implemented into routine clinical practice to increase diagnostic and predictive capabilities of clinical-based stratification models. Recent clinical studies have shown that development of endothelial dysfunction in HF could relate to activation and/or apoptosis of endothelial cells. Worsening endothelium integrity and function relate to release of newly detectable circulating biomarkers called endothelial cell derived microparticles (EMPs). The commentary is discussed the role of impaired immune pattern of circulating EMPs associated with elevated number of apoptotic endothelial cell-derived microparticles in prediction of HFpEF development.
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