Assessing inflammation in Chinese subjects with subtypes of heart failure: an observational study of the Chinese PLA Hospital Heart Failure Registry

BACKGROUND: Inflammation is an important element of the pathophysiological process of heart failure (HF) and is correlated with subtypes of HF. The association between multiple biomarkers of inflammation and HF subtypes in Chinese subjects remains unclear. This study aimed to compare the differences in inflammation biomarkers among Chinese patients with different subtypes of HF who have been identified to date. METHODS: We included 413 consecutive patients with HF, including 262 with preserved ejection fraction (HFpEF), 55 with middle-ranged ejection fraction (HFmrEF) and 96 with reduced ejection fraction (HFrEF). Ten inflammation biomarkers were analyzed and compared according to the HF subtypes. One hundred contemporary non-HF subjects were also recruited as the control group. Moreover, the correlations between the inflammatory biomarkers and left ventricular ejection fraction of the HF subtypes were assessed. RESULTS: The mean age of the HF patients was 65.0 ± 12.0 years, 65.8% were male. Distinct subtypes of HF demonstrated different inflammation biomarker panels. IL-6, PTX-3, ANGPTL-4 and TNF-α were correlated with HFrEF; IL-1β and PTX-3 were correlated with HFmrEF; and IL-1β and IL-6 were correlated with HFpEF. The multivariable logistic regression showed that IL-1β [relative ratio (RR) = 1.08, 95% CI: 1.02–1.15, P = 0.010], IL-6 (RR = 1.03, 95% CI: 1.01–1.06, P = 0.016), PTX-3 (RR = 1.31, 95% CI: 1.11–1.55, P = 0.001), and ANGPTL-4 (RR = 1.05, 95% CI: 1.02–1.07, P < 0.001) were independently associated with HF, while IL-6 (RR = 1.03, 95% CI: 1.01–1.04, P = 0.019), PTX-3 (RR = 1.23, 95% CI: 1.06–1.43, P = 0.007), and ANGPTL-4 (RR = 1.03, 95% CI: 1.01–1.06, P = 0.005) were independently associated with the HF subtype. CONCLUSIONS: Diverse inflammation biomarkers have multifaceted presentations according to the subtype of HF, which may illustrate the diverse mechanisms of inflammation in Chinese HF patients. IL-6, PTX-3, and ANGPTL-4 were independent inflammation factors associated with HFrEF and HF.