Multimarker Approach Including High-Sensitivity Cardiac Troponin, NT-proBNP, and Growth Differentiation Factor-15 for Risk Stratification and Therapeutic Decision-Making in Elderly Patients with Acute Heart Failure with Preserved Ejection Fraction: The SENIOR-HFpEF Prospective Cohort Study

Acute heart failure with preserved ejection fraction (HFpEF) represents a growing clinical challenge, particularly among elderly patients, who frequently present with complex comorbidities, frailty, and heterogeneous pathophysiological mechanisms. Traditional clinical and imaging-based risk stratification tools often fail to adequately capture the multifactorial nature of HFpEF and its associated prognostic variability. Circulating biomarkers reflecting myocardial injury, hemodynamic stress, systemic inflammation, and biological aging have emerged as promising tools to improve risk assessment and guide individualized therapeutic strategies. High-sensitivity cardiac troponin provides sensitive detection of ongoing myocardial injury, while N-terminal pro–B-type natriuretic peptide (NT-proBNP) reflects ventricular wall stress and hemodynamic burden. Growth differentiation factor-15 (GDF-15), a biomarker associated with oxidative stress, inflammation, and cellular senescence, has shown strong prognostic value in elderly cardiovascular populations. The combined use of these biomarkers may offer incremental prognostic accuracy beyond conventional clinical models. The SENIOR-HFpEF prospective cohort study aims to evaluate the prognostic and therapeutic utility of an integrated multimarker strategy in elderly patients hospitalized with acute HFpEF. The study will assess the association between biomarker profiles and short- and long-term outcomes, including mortality, rehospitalization, functional decline, and quality of life. Additionally, the study will explore the role of multimarker-guided therapeutic decision-making, including optimization of diuretic therapy, neurohormonal modulation, and individualized post-discharge management. This investigation seeks to advance precision medicine approaches in HFpEF by integrating biomarker-driven risk stratification with geriatric-focused clinical management, potentially improving outcomes and optimizing healthcare resource utilization in this vulnerable patient population.