The Increase of Soluble Urokinase Plasminogen Activator Receptor in Heart Failure is Related to Disease Severity and Cardiac Mortality

Heart failure (HF) is a life-threatening syndrome with high prevalence and mortality rates. Soluble urokinase plasminogen activator receptor (suPAR) is increased in HF and it has been related to adverse outcomes in cardiorenal diseases. We assessed suPAR concentrations in HF patients with reduced left ventricular ejection fraction (HFrEF) and its relation with disease severity and cardiac biomarkers. We measured suPAR plasma concentrations in 93 patients with either ischaemic heart disease or dilated cardiomyopathy (73 males, 20 females, mean age 65 years) by using an ELISA assay. Based on predefined cut-offs, patients were stratified into low- (< 4 ug/L), medium- (4–6 ug/L), and high-risk (> 6 ug/L) groups. Circulating levels of other cardiac biomarkers (NT-proBNP, Galectin-3, and ST2) were determined with immunoassays. The mean suPAR concentration was 6.00 ug/L. The mean suPAR value was 4.40 ug/L, 6.92 ug/L, and 6.93 ug/L in the New York Heart Association (NYHA) II, III, and IV classes, respectively. 57% of patients died from adverse cardiovascular events. The mean left ventricular ejection fraction (LVEF) in low- to high-risk groups was 23%, 22.97%, and 22.49%, respectively. Significant and positive relationships were observed with NT-proBNP, Galectin-3, and ST2. The mean suPAR concentration was on the cut-off line between medium- and high-risk groups. SuPAR values in NYHA II were lower than in NYHA III and IV. There was no correlation between the decrease of LVEF and the suPAR concentrations. Testing for suPAR could represent a novel risk stratification biomarker for HFrEF as well as a novel potential target to evaluate treatment efficiency.