Cardiac markers for risk stratification and prognosis in elderly patients with HFpEF

Introduction: Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent among the elderly, particularly women, and is characterized by complex pathophysiology driven by comorbidities such as hypertension, diabetes, and renal dysfunction. These overlapping mechanisms make diagnosis and prognosis challenging, highlighting the importance of circulating biomarkers that reflect key biological processes such as myocardial stretch, fibrosis, inflammation, and injury. Objective: This mini-review explores the diagnostic and prognostic roles of major cardiac biomarkers BNP/NT-proBNP, high-sensitivity troponins, soluble suppression of tumorigenicity 2 (sST2), and Galectin-3 in elderly patients with HFpEF. Results: BNP and NT-proBNP remain the cornerstone biomarkers for diagnosing HFpEF, reflecting ventricular wall stress and providing strong prognostic value, although their interpretation in older adults can be influenced by renal function, age, and comorbidities. High-sensitivity troponins indicate chronic myocardial injury and have emerged as reliable predictors of mortality and recurrent hospitalizations. sST2 reflects inflammatory and fibrotic remodeling; while limited diagnostically, it shows consistent association with adverse outcomes. Galectin-3 captures ongoing myocardial fibrosis and structural remodeling, offering particularly strong prognostic information in HFpEF compared to HFrEF. Conclusion: Collectively, these biomarkers represent complementary windows into the pathophysiology of HFpEF. A multimarker strategy that integrates markers of wall stress, injury, inflammation, and fibrosis may enhance diagnostic precision and risk stratification in elderly patients, guiding more personalized approaches to management.