Background: Insulin-like growth factor binding protein-7 (IGFBP-7) modulates the biological activities of insulin-like\ngrowth factor-1 (IGF-1). Previous studies demonstrated the prognostic value of IGFBP-7 and IGF-1 among patients\nwith systolic heart failure (HF). This study aimed to evaluate the IGF1/IGFBP-7 axis in HF patients with preserved\nejection fraction (HFpEF).\nMethods: Serum IGF-1 and IGFBP-7 levels were measured in 300 eligible consecutive patients who underwent\ncomprehensive cardiac assessment. Patients were categorized into 3 groups including controls with normal\ndiastolic function (n = 55), asymptomatic left ventricular diastolic dysfunction (LVDD, n = 168) and HFpEF (n = 77).\nResults: IGFBP-7 serum levels showed a significant graded increase from controls to LVDD to HFpEF (median\n50.30 [43.1-55.3] vs. 54.40 [48.15-63.40] vs. 61.9 [51.6-69.7], respectively, P < 0.001), whereas IGF-1 levels showed\na graded decline from controls to LVDD to HFpEF (120.0 [100.8-144.0] vs. 112.3 [88.8-137.1] vs. 99.5 [72.2-124.4],\np < 0.001). The IGFBP-7/IGF-1 ratio increased from controls to LVDD to HFpEF (0.43 [0.33-0.56] vs. 0.48 [0.38-0.66] vs. 0.68\n[0.55-0.88], p < 0.001). Patents with IGFB-7/IGF1 ratios above the median demonstrated significantly higher left\natrial volume index, E/E� ratio, and NT-proBNP levels (all P � 0.02).\nConclusion: In conclusion, this hypothesis-generating pilot study suggests the IGFBP-7/IGF-1 axis correlates with\ndiastolic function and may serve as a novel biomarker in patients with HFpEF. A rise in IGFBP-7 or the IGFBP-7/IGF-1\nratio may reflect worsening diastolic function, adverse cardiac remodeling, and metabolic derangement.
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