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Abstract   Aims  Metabolic derangement is implicated in the pathophysiology of heart failure (HF) and pulmonary hypertension (PH). We aimed to identify the dynamics of metabolic plasma proteins linked to end‐stage HF and associated PH in relation to haemodynamics, before and after heart transplantation (HT).    Methods and results  Twenty‐one metabolic plasma proteins were analysed with proximity extension assay in 20 controls and 26 patients before and 1 year after HT. Right heart catheterizations were performed in the HF patients pre‐operatively and 1 year after HT. Plasma levels of soluble receptor for advanced glycation end products (sRAGE) and insulin‐like growth factor‐binding protein 7 (IGFBP7) were higher in HF patients compared with controls ( P  &lt; 0.0001) and decreased after HT ( P  &lt; 0.0001), matching controls' levels. The decrease in sRAGE after HT correlated with improved mean pulmonary arterial pressure ( r   s   = 0.7;  P  &lt; 0.0001), pulmonary arterial wedge pressure ( r   s   = 0.73;  P  &lt; 0.0001), pulmonary vascular resistance ( r   s   = 0.65;  P  = 0.00062), and pulmonary arterial compliance ( r   s   = −0.52;  P  = 0.0074). The change in plasma IGFBP7 after HT correlated with improved mean right atrial pressure ( r   s   = 0.71;  P  = 0.00011) and N‐terminal pro‐brain natriuretic peptide ( r   s   = 0.71;  P  &lt; 0.0001).    Conclusions  Our results indicate that plasma sRAGE may reflect passive pulmonary vascular congestion and the ‘mechanical’ state of the pulmonary vasculature in HF patients with or without related PH. Furthermore, sRAGE and IGFBP7 may provide additional insight into the pathophysiological mechanisms in HF and associated PH. Their potential clinical and therapeutic relevance in HF and associated PH need further investigation.

Elevated plasma sRAGE and IGFBP7 in heart failure decrease after heart transplantation in association with haemodynamics