The plasma levels of alpha-1-microglobulin/bikunin precursor (AMBP), lipoprotein lipase (LPL), and glyoxalase I may help distinguish heart failure with preserved ejection fraction with pulmonary hypertension (HFpEF-PH) from pulmonary arterial hypertension (PAH), as published in the International Journal of Cardiology.

HFpEF-PH and PAH are very similar in terms of clinical and comorbid characteristics. However, it is important to distinguish the 2 diseases to ensure that patients are managed and treated in the right way.

Here, a team of researchers led by Göran Rådegran, DMSc, MD, investigated tumor and metabolism-related proteins in an attempt to differentiate HFpEF-PH from PAH.

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Using proximity extension assay, the team analyzed 69 tumor and metabolism plasma proteins in 48 patients with PAH, 67 with left heart failure-PH of which 31 had HFpEF-PH and 36 had HF reduced EF-PH, and 20 healthy controls.

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The results showed that the levels of AMBP and LPL were higher in the plasma of patients with HFpEF-PH compared to healthy controls. Similarly, the levels of glyoxalase I was higher in patients with HFpEF-PH and HF reduced EF-PH compared to healthy controls and to patients with PAH.

When adjusted for age and sex in multivariable logistic regression models, plasma AMBP, LPL, and glyoxalase I could each differentiate HFpEF-PH from PAH. The combination of the 3 biomarkers led to the most reliable distinction between the 2 conditions.

Finally, the researchers showed that the plasma levels of AMBP correlated with pulmonary arterial wedge pressure, a measure of the compliance of the left side of the heart and pulmonary circulation.

They concluded that AMBP, LPL, and glyoxalase I may have the potential to facilitate the clinical distinction between HFpEF-PH and PAH. They added that larger clinical studies are needed to confirm and validate these findings.


Ahmed S, Ahmed A, Rådegran G. Plasma tumour and metabolism related biomarkers AMBP, LPL and Glyoxalase I differentiate heart failure with preserved ejection fraction with pulmonary hypertension from pulmonary arterial hypertension. Int J Cardiol. 2021;15(345):68-76. doi:10.1016/j.ijcard.2021.10.136