Endothelial Dysfunction and Inflammatory Pathways in Heart Failure - Role of suPAR and sVCAM-1 as Novel Biomarkers.

Abstract

Introduction: Heart failure (HF) is a multifactorial clinical syndrome characterised by myocardial remodelling, endothelial dysfunction, and chronic inflammation. Emerging evidence highlights the role of inflammatory and endothelial biomarkers, particularly soluble urokinase plasminogen activator receptor (suPAR) and soluble vascular cell adhesion molecule-1 (sVCAM-1), in improving our understanding and management of HF.

Methods: A narrative review of the literature was conducted to evaluate the biological significance, clinical utility, and prognostic relevance of suPAR and sVCAM-1 in HF. Given the heterogeneity of study designs, HF phenotypes, and clinical outcomes, the available evidence was critically synthesised to provide an integrated overview of these biomarkers.

Results: Endothelial dysfunction and persistent inflammation were identified as key contributors to the pathogenesis of HF. Elevated suPAR levels are associated with immune activation, myocardial remodelling, renal dysfunction, increased rehospitalisation, and mortality. Similarly, increased sVCAM-1 concentrations reflect endothelial activation and vascular inflammation and are linked to adverse cardiac remodelling and poor clinical outcomes. Both biomarkers have potential value in early diagnosis, risk stratification, and therapeutic monitoring, particularly in patients with heart failure with preserved ejection fraction (HFpEF).

Discussion: suPAR and sVCAM-1 provide complementary information beyond that of conventional natriuretic peptides by capturing the inflammatory and endothelial mechanisms involved in HF progression. The incorporation of these markers into multi-marker strategies may improve risk assessment and support personalised treatment approaches.

Conclusion: suPAR and sVCAM-1 are promising biomarkers for enhancing diagnosis, prognostic assessment, and therapeutic monitoring in HF. Further multicentre prospective studies are needed to validate their clinical utility and establish their roles in precision heart failure management.