Objective To analyze the correlation between multiple cardiac biomarkers (sST2, apelin, and CPP) and the prognosis of patients with heart failure (HF) with different ejection fractions (EFs).

Methods A total of 119 patients with HF admitted to Fujian Jinshan Hospital from November 2018 to May 2020 were included. Patients were divided into 3 groups according to the left ventricular EF: the heart failure with reduced EF (HFrEF) group (n=31), the heart failure with middle-range EF (HFmrEF) group (n=21), and the heart failure with preserved EF (HFpEF) group (n=67). The novel serum biomarkers including N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble suppression of tumorigenicity-2 (sST2), apelin, and copeptin (CPP) were detected. All patients were treated with the standard therapies. All patients were followed up for 2 years until the cardiovascular death. The relationships between cardiac biomarkers and cardiovascular death were analyzed.

Results There were statistically significant differences in gender, systolic blood pressure, pulse pressure, body mass index, urea nitrogen, glycosylated hemoglobin, left ventricle end-systolic diameter, transverse right atrium diameter, and right ventricular end-systolic diameter among different EF groups (P < 0.05). There were statistically significant differences in NT-proBNP and sST2 among different EF groups (P < 0.05), however, no difference in CPP and apelin were observed. Multivariate general linear model analysis showed that there was correlations in NT-proBNP level and EF (F=3.49, P=0.03), while there was no significant difference in levels of sST2, apelin, and CPP. Within 24 months of follow-up, the accumulated cardiovascular mortality of patients in HFrEF, HFmrEF, and HFpEF groups was 29.0%, 23.8%, and 10.4%, respectively, and the difference had statistically significant (P=0.04). Kaplan-Meier survival curves analysis results showed that cumulative surval rate in HFrEF, HFmrEF, and HFpEF groups increased in sequence (χ²=6.48, P=0.04). Cox regression analysis results showed that NT-proBNP, urea nitrogen, and taking mineralocorticoid receptor antagonists were the influence factors for cardiovascular death of HF patients (P < 0.01).

Conclusions EF, NT-proBNP, urea nitrogen, and taking mineralocorticoid receptor antagonists would predict cardiovascular death in patients with HF, however, the levels of sST2, apelin, and CPP have limited predictive value for cardiovascular death in patients with HF.