{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T21:03:30Z","timestamp":1790975010543,"version":"4.1.0"},"reference-count":57,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Background: Despite existing evidence of the high predictive value of natriuretic peptides (NPs) in patients with heart failure (HF), patients treated with guideline-directed therapy who have low or near-normal NP levels are unlikely to be correctly stratified for risk of clinical outcomes. The aim of this study is to detect plausible predictors for poor one-year clinical outcomes in patients with HFpEF and low NT-proBNP treated with in accordance with conventional guidelines. Methods: A total of 337 patients with HF with preserved ejection fraction (HFpEF) who had low levels of N-terminal natriuretic pro-peptide (NT-proBNP) at discharge due to optimal guideline-based therapy were enrolled in the study. The course of the observation was 3 years. Echocardiography and the assessment of conventional hematological and biochemical parameters, including NT-proBNP, tumor necrosis factor-alpha, high-sensitivity C-reactive protein (hs-CRP), adropin, irisin, visfatin, and fetuin-A, were performed at baseline and at the end of the study. Results: Three-year cumulative clinical endpoints (cardiovascular death, myocardial infarction or unstable angina or acute coronary syndrome, worsening HF, sudden cardiac death, or cardiac-related surgery or all-cause death) were detected in 104 patients, whereas 233 did not meet the endpoint. After adjusting for an age \u2265 64 years and a presence of atrial fibrillation, diabetes mellitus, chronic kidney disease (CKD) stages 1\u20133 and dilated cardiomyopathy, the multivariable Cox regression analysis showed that an irisin level of \u22647.2 ng\/mL was an independent predictor of cumulative clinical endpoint. Moreover, patients with levels of irisin &gt; 7.2 ng\/mL had a better Kaplan\u2013Meier survival rate than those with a lower serum irisin level (\u22647.2 ng\/mL). Conclusions: Multivariable analysis showed that an age \u2265 64 years; the presence of atrial fibrillation, diabetes mellitus, CKD stages 1\u20133 and dilated cardiomyopathy; an LAVI \u2265 39 mL\/m2; and serum levels of hs-CRP \u2265 6.10 mg\/L, irisin \u2264 7.2 ng\/mL, and visfatin \u2264 1.1 ng\/mL were predictors of poor clinical outcomes in HFpEF with low levels of NT-proBNP. A serum level of irisin \u2264 7.2 ng\/mL could emerge as valuable biomarker for predicting long-term prognosis among HFpEF patients with low or near-normal levels of NT-proBNP.<\/jats:p>","DOI":"10.3390\/biom14121615","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T10:54:02Z","timestamp":1734432842000},"page":"1615","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Irisin Predicts Poor Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction and Low Levels of N-Terminal Pro-B-Type Natriuretic Peptide"],"prefix":"10.3390","volume":"14","author":[{"given":"Tetiana A.","family":"Berezina","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Nephrology, VitaCenter, 69000 Zaporozhye, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleksandr O.","family":"Berezin","sequence":"additional","affiliation":[{"name":"Luzerner Psychiatrie AG, 4915 St. Urban, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5864-0604","authenticated-orcid":false,"given":"Evgen V.","family":"Novikov","sequence":"additional","affiliation":[{"name":"Department of Functional Diagnostics, Shupyk National Healthcare University of Ukraine, 04136 Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lichtenauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0446-3999","authenticated-orcid":false,"given":"Alexander E.","family":"Berezin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1136\/heartjnl-2021-320131","article-title":"Prevalence, incidence and survival of heart failure: A systematic review","volume":"108","author":"Johnson","year":"2022","journal-title":"Heart"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/ejhf.483","article-title":"Epidemiology of heart failure: The prevalence of heart failure and ventricular dysfunction in older adults over time. 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