Comorbidities: contributors & confounding factors in heart failure
| PhD ceremony: | E.M. Screever |
| When: | September 15, 2025 |
| Start: | 16:15 |
| Supervisors: | R.A. (Rudolf) de Boer, prof. dr. D.J. (Dirk Jan ) van Veldhuisen |
| Where: | Academy building RUG / Student Information & Administration |
| Faculty: | Medical Sciences / UMCG |
Comorbidities: contributors & confounding factors in heart failure
Heart failure is a clinical syndrome in which the heart is no longer able to pump a sufficient amount of blood to meet the body’s demands. Heart failure is associated with high morbidity and mortality and predominantly affects elderly, who often present with multiple comorbidities and polypharmacy. These comorbidities strongly contribute to prognosis and complicate both diagnosis and treatment, particularly in patients with heart failure with preserved ejection fraction (HFpEF).
This thesis of Elles Screever demonstrates that heart failure patients have a high burden of comorbidities, which play a crucial role in disease prognosis. Compared with 15 years ago, obesity appears to have become an increasingly important factor influencing the course of heart failure.
Diagnosing HFpEF remains a major challenge. Cardiac echocardiographic parameters, such as LAVi and LVMi are often used. However, we show that these measures are not always predictive of HFpEF and sometimes fit better with patients with heart failure with reduced ejection fraction (HFrEF), underscoring the difficulty of HFpEF diagnosis.
In addition to echocardiography, biomarkers are frequently applied for diagnosis and disease monitoring. Our results show that comorbidities can affect biomarker values. For example, creatinine proved less reliable for assessing kidney function in patients with neuromuscular disease, while individuals with blood group O had higher galectin-3 levels but with lower prognostic value compared with other blood groups.
Finally, we investigated novel biomarkers—immune checkpoints. We show that serum levels are elevated in heart failure patients and correlate strongly with established cardiac biomarkers, and are closely associated with prognosis. Immune checkpoints may therefore hold promise as future biomarkers or therapeutic targets.
This thesis provided insight in the complexity of heart failure.