Increased Plasma Pyruvate Kinase M2 (PK‐M2) in Heart Failure: A Novel Biomarker Related to Cardiac Function and its Clinical Implications

• Published in: Journal of the American Heart Association Vol. 14; no. 2; p. e036170
• Main Authors: Cao, Lu, Dong, Xiaoyu, Chen, Fuzhong, Li, Guangjuan, Fang, Jiale, Han, Zhijun, Wang, Junhong
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 21.01.2025; Wiley
• Subjects: Aged; biomarker; Biomarkers - blood; Case-Control Studies; Disease Progression; Enzyme-Linked Immunosorbent Assay; Female; heart failure; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - enzymology; Heart Failure - mortality; Heart Failure - physiopathology; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Original Research; Patient Readmission; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Pyruvate Kinase - blood; pyruvate kinase M2; Risk Factors; Severity of Illness Index; short‐term prognosis; Stroke Volume; Time Factors; Up-Regulation; Ventricular Function, Left; short‐term prognosis; heart failure; biomarker; pyruvate kinase M2
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.036170

The purpose of this study was to investigate whether circulating pyruvate kinase M2 (PK-M2) levels are elevated in the peripheral blood and to assess their association with diagnosis and prognosis in patients with heart failure (HF). We conducted a prospective investigation involving 222 patients with HF and 103 control subjects, measuring PK-M2 concentrations using ELISA. The primary outcome, assessed over a median follow-up of 2 years (interquartile range: 776 to 926 days), was the time to the first occurrence of either rehospitalization for worsening HF or cardiovascular death. Patients with HF had higher PK-M2 levels than controls (17.4±4.1 versus 7.8±2.3 U/mL, <0.001), and these levels correlated with HF severity (New York Heart Association cardiac function class). Patients with reduced left ventricular ejection fraction had higher PK-M2 concentrations than those with preserved ejection fraction (18.3±4.5 versus 16.7±3.6 U/mL, <0.01). In a subset of patients with HF (n=52), PK-M2 levels significantly decreased following standardized HF treatment (mean difference, -4.3±0.5 U/mL, <0.001). A high PK-M2 level had a 1.913-fold higher risk of the primary outcome ( =0.033) after adjusting for multiple cardiovascular risk factors, but not with cardiovascular death. Additionally, PK-M2 added incremental prognostic value beyond clinical predictors and N-terminal pro-brain natriuretic peptide ( <0.05). Elevated PK-M2 levels are associated with primary outcomes and rehospitalization for worsening heart failure in patients with HF. These findings suggest that PK-M2 is a potential biomarker for HF diagnosis and prognosis, warranting consideration for serial patient assessment.