Heart failure among patients with prediabetes and type 2 diabetes mellitus: diagnostic and predictive biomarkers: a narrative review

Abstract

Objective: This narrative review is to provide an updated view of circulating biomarkers to improve diagnosis and prognosis in heart failure (HF) patients with diabetes mellitus (DM) and pre-diabetes (pre-DM). Background: HF is a leading cause of premature death among patients with overt cardiovascular (CV) disease worldwide. Natriuretic peptides (NPs) and high sensitive cardiac troponins remain powerful tools to stratify, diagnose, and manage patients at risk of HF and with established HF. Methods: The bibliographic databases of MEDLINE, EMBASE, Medline (PubMed), Web of Science, and Cochrane Central were searched for English publications using the following key words [heart failure]; [diabetes mellitus], [type 2 diabetes mellitus], [pre-diabetes]; [pre-T2DM]; [cardiovascular risk], [cardiovascular risk factors], [cardiac biomarkers]; [circulating biomarkers]; and [prognosis]. Conclusions: NPs demonstrated their optimal ability to diagnose and predict HF with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction regardless of presentation of different metabolic comorbidities, such as DM and pre-DM. The role of soluble suppressor of tumorigenesis-2 (sST2), growth differential factor-15 (GDF15), and galectin-3 are critically discussed in terms of the improvement of incremental value of conventional biomarker strategies to predict CV and HF-related outcomes. We found alternative biomarkers reflecting several pathological stages of HF progression (inflammation, endothelial dysfunction, oxidative stress, altered vascular and myocardial reparation, adipose tissue dysfunction, and skeletal muscle metabolism) continue to be deeply investigated as new powerful tools to improve the discriminative potency of traditional predictive scores in patients with HFrEF, HFmrEF, and HFpEF.