Plasma VEGF-D and sFLT-1 are potential biomarkers of hemodynamics and congestion in heart failure and following heart transplantation

Background Inflammation and tyrosine-kinases are known mediators in the pathobiology of cardiovascular disease. Plasma biomarkers reflecting these systems may provide a noninvasive complement reflecting hemodynamics, aiding in clinical decision-making. We therefore aimed to investigate the plasma levels of vascular and inflammatory proteins, and their associations with invasive hemodynamics in advanced heart failure (HF) before, and at multiple follow-ups after heart transplantation (HT).Methods Using multiplex sandwich immunoassays, absolute plasma concentrations of 9 vascular and inflammatory proteins were assessed in 26 patients with advanced HF, before HT, and at 4 weeks, 6 months, and 1year after HT. Right heart catheterization hemodynamics were assessed at the time of blood sampling. Repeated measures correlations were performed to evaluate the overall intra-individual development of plasma protein levels in relation to hemodynamics' development over time.Results Out of 9 proteins included initially, in advanced HF, elevated plasma levels of vascular endothelial growth factor D (VEGF-D) and soluble fms-like tyrosine kinase-1 (sFlt-1) decreased most markedly at 4 weeks (p p p r mr = 0.75, 95% bootstrapped confidence interval (CI) 0.61-0.84, p r mr = 0.74, 95% CI 0.61-0.82, p r mr = 0.74, 95% CI 0.58-0.82, p r mr = 0.66, 95% CI 0.58-0.79, p r mr = 0.64, 95% CI 0.58-0.81, p r mr = 0.61, 95% CI 0.51-0.76, p Conclusions In advanced HF, elevated plasma VEGF-D and sFlt-1 levels decrease early, already within 4 weeks after HT, and further throughout the first year postoperatively. Our findings support that high plasma VEGF-D and sFlt-1 concentrations before HT are related to congestion and overall hemodynamic improvement. Plasma VEGF-D and sFlt-1 may consequently be potential noninvasive biomarkers for monitoring hemodynamic deterioration and congestion in HF, and surveillance after HT.