Patients with acute heart failure (HF) and low concentrations of vascular endothelial growth factor C (VEGF-C) on admission show a higher mortality after a year compared with patients with higher VEGF-C concentrations. Due to its association with factors for cellular adhesion, VEGF-C may be used as an indicator of peripheral congestion.

Patients presenting with severe signs of peripheral congestion from acute HF have a worse prognosis in terms of 1-year mortality and the composite endpoint of 1-year mortality or HF re-hospitalization. Therefore, serologic markers for tissue congestion would assist in helping make clinical decisions and assessing the prognosis of patients with acute HF. Gracjan Iwanek, MD, measured VEGF-C serum levels on admission and at discharge in 237 patients hospitalized for acute HF and assessed their influence on prognosis. He then stratified the study population into the following VEGF-C tertiles: low (33 pg/mL), medium (606 pg/mL), and high (1141 pg/mL).

The low VEGF-C group on admission showed a significant increase in serum levels during hospitalization (from 33 [95% CI, 15–175] pg/mL to 465 [95% CI, 327–648] pg/mL; P<.001), whereas the medium VEGF-C group did not change during the hospital stay. In contrast, there was a significant drop in serum VEGF-C levels in the high VEGF-C group (from 1141 [95% CI, 967–1443] to 704 [95% CI, 477–1009] pg/mL; P<.001). Therefore, VEGF-C serum levels from different tertiles on admission shifted in a common direction.

The 1-year mortality was highest in the low VEGF-C tertile and lower in the other 2 tertiles (35% vs 28% in the medium tertile and 18% in the high tertile; P=.048). The same pattern was observed for a composite endpoint of death and acute HF re-hospitalization: 45% (low tertile) vs 43% (medium tertile), vs 26% (high tertile) (P=0.029).

To shed light on the pathophysiology behind the VEGF-C release, Dr. Iwanek also assessed different cardiovascular biomarkers and molecules responsible for cellular adhesion.

VEGF concentrations showed no association with NT-proBNP, Creatinine, and troponin but to molecules responsible for cellular adhesion (eg, galectin-3, selectin, and ICAM-1) and communication.

These results further suggest VEGF-C is related to peripheral tissue congestion; therefore, its use as an indicator of peripheral congestion may be justified.

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