Qingyu Zhang, Zongliang Yu

Department of Cardiology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, Jiangsu, People’s Republic of China

Correspondence: Zongliang Yu, Department of Cardiology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, Jiangsu, 215300, People’s Republic of China, Email zl-yu@sohu.com

Objective: Heart failure with preserved ejection fraction (HFpEF) is becoming increasingly prevalent, yet clinical practice lacks specific biomarkers, early diagnostic tools, and reliable risk assessment methods. Given the growing burden of HFpEF, identifying novel diagnostic markers is crucial. This study investigates the diagnostic potential of apolipoprotein C3 (ApoC3) in HFpEF and its correlation with ventricular structure.
Methods: We analyzed data from HFpEF patients admitted to the Kunshan Branch of Gusu College of Nanjing Medical University and the First People’s Hospital of Kunshan (March–December 2023). Controls included HFrEF+HFmrEF patients and healthy individuals. Enzyme-linked immunosorbent assay (ELISA) was used to detect the concentration of ApoC3 in all collected cases. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of ApoC3 alone and combined with the fibrinogen-to-albumin ratio (FAR) in plasma, and the relative wall thickness (RWT) in echocardiography for HFpEF.
Results: After exclusions, 80 HFpEF patients (39 male, 41 female), 41 HFrEF+HFmrEF patients (27 male, 14 female), and 79 healthy controls (53 male, 26 female) were included. ApoC3 levels were significantly higher in HFpEF (63136.03± 12,113.07 ng/mL) than in HFrEF+HFmrEF (55580.84± 13,685.35 ng/mL) and controls (53090.31± 5893.25 ng/mL, P< 0.001). ROC analysis demonstrated that ApoC3 alone (AUC=0.836) and the combined index (ApoC3+FAR+RWT, AUC=0.891) effectively distinguished HFpEF. Both also aided in differentiating HFpEF from HFrEF+HFmrEF (AUC=0.702 vs 0.823).
Conclusion: ApoC3 is a promising biomarker for HFpEF diagnosis, and the combined index (ApoC3+FAR+RWT) enhances diagnostic accuracy. These findings may improve early detection and clinical management of HFpEF.

Keywords: heart failure with preserved ejection fraction, apolipoprotein C3, fibrinogen-to-albumin ratio, relative wall thickness, diagnosis