DeLisa Fairweather, Ph.D., Mayo Clinic, Jacksonville, FL, USA
Background: Our preclinical animal and preliminary clinical data indicate that sex differences exist for a number of sera biomarkers of heart failure in myocarditis and acute dilated cardiomyopathy (DCM) patients. We have found that sex differences exist for sST2, vitamin D, vitamin D binding protein and interleukin-1 receptor antagonist, for example, that correlate to markers of heart failure like low ejection fraction and New York Heart Association (NYHA) class in a sex-specific manner.
Objectives/Methods: In this study we examined whether sex differences existed in 1) sera biomarkers that predict poor cardiac function/ heart failure and 2) whether sera biomarkers correlated to % ejection fraction, NYHA class, BNP/NT-proBNP and/or CRP by sex and age (i.e., menopause status in women using age 50 as a cut off) in men and women with myocarditis or acute DCM. We also examined these parameters in a mouse model of coxsackievirus-induced myocarditis/DCM.
Results: We have found that sex differences exist for all heart failure biomarkers that we have examined so far in the mouse model and in patients. For sST2, only men drove the association of sST2 and NYHA class, with women’s levels of sST2 below those of men. A similar result was observed in the mouse model with higher levels of sST2 correlating to low ejection fraction in mice with myocarditis. Interestingly, sera sST2 levels were increased past age 50 in both men and women. In contrast, circulating vitamin D levels display sex differences but an inverse relationship exists for vitamin D compared to % ejection fraction or NHYA class in men and women or male and female mice with myocarditis.
Conclusions: These findings highlight the critical importance of examining biomarkers of heart failure in the context of sex and age as we adopt a more personalized medicine approach to healthcare.