Plasma Levels of Activin A and Follistatin-Like-3 as Biomarkers for Pulmonary Hypertension in Advanced Heart Failure

Introduction: Pulmonary hypertension (pHTN) is a serious condition associated with increased mortality and morbidity, with limited early and non-invasive diagnostic tools. This study aimed to investigate the potential of plasma biomarkers Activin A and Follistatin-Like-3 (FSTL3) as indicators of disease severity in pHTN and right heart dysfunction. Methods: We conducted a prospective cohort study of 120 patients with advanced heart failure undergoing right heart catheterization. Plasma levels of Activin and FSTL3 were measured at the time of the catheterization. Biomarker data was analyzed for correlation with values from right heart catheterization, including pulmonary artery pressure and right ventricular work. Results: Both Activin A and FSTL3 levels were elevated in patients with pHTN compared to controls. Additionally, Activin A and FSTL3 were positively correlated with mean pulmonary artery pressure and right ventricular work, suggesting their potential as biomarkers for monitoring pHTN progression. In contrast, pro-BNP did not correlate with right ventricular work. Conclusion: Results align with prior research indicating the importance of the activin signaling pathway in pHTN and support the hypothesis that measuring Activin and FSTL3 levels could offer a non-invasive method for diagnosing and monitoring disease progression in pHTN. Further studies are needed to validate these biomarkers in broader patient populations, which could ultimately enable earlier interventions and improve outcomes in pulmonary hypertension management.