Soluble ST2 and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction

Area of Science:

• Cardiology
• Nephrology
• Biomarkers

Background:

• Identifying patients with acute heart failure (AHF) at risk of poor diuretic response is crucial for timely therapeutic adjustments.
• Renal dysfunction is common in AHF and can impact treatment outcomes.

Purpose of the Study:

• To investigate if soluble ST2 (sST2) levels predict cumulative diuretic efficiency (DE) in AHF patients with renal dysfunction.
• To assess the association between sST2 and DE at 24 and 72 hours.

Main Methods:

• Post hoc analysis of the IMPROVE-HF trial including 160 AHF patients with renal dysfunction (eGFR <60 mL/min/1.73 m²).
• Diuretic efficiency (DE) calculated as net fluid output per 40 mg furosemide equivalents.
• Multivariate linear regression used to evaluate the sST2 and DE association.

Main Results:

• Median cumulative DE at 24 and 72 hours was 747 mL and 1844 mL, respectively.
• Median sST2 level was 72 ng/mL; mean eGFR was 34.0 mL/min/1.73 m².
• Higher sST2 levels were significantly and nonlinearly associated with lower DE at both 24 and 72 hours (P=.002 and P=.019).

Conclusions:

• Circulating sST2 levels are independently and negatively associated with diuretic response in AHF patients with renal dysfunction.
• sST2 may serve as a predictive biomarker for diuretic response in this patient population.
• These findings support considering sST2 levels for optimizing AHF management in patients with impaired kidney function.