Identifying patients at risk of poor diuretic response in acute heart failure (AHF) is critical to make prompt adjustments in therapy. The objective of this study was to investigate whether the circulating levels of soluble ST2 predict the cumulative diuretic efficiency (DE) at 24- and 72-hour in patients with AHF and concomitant renal dysfunction (RD).
This is a post-hoc analysis of the IMPROVE-HF trial, in which we enrolled 160 patients with AHF and RD [estimated glomerular filtrate rate (eGFR) <60 mL/min/1.73m2]. DE was calculated as the net fluid output produced per 40 mg of furosemide equivalents. The association between sST2 and diuretic efficiency was evaluated by using multivariate linear regression analysis. The median (interquartile range) cumulative DE at 24- and 72-hour was 747 ml (490-1167) and 1844 ml (1142-2625), respectively. The median (interquartile range) sST2, and mean eGFR were 72 ng/mL (47-117), and 34.0±8.5 ml/min/1.73m2, respectively. In a multivariable setting, higher sST2 were significant and non-linearly related to lower DE both at 24- and 72-hour (P=0.002 and P=0.019, respectively).
In patients with AHF and RD at presentation, circulating levels of sST2 were independently and negatively associated with a poor diuretic response, both at 24- and 72-hour.

Copyright © 2020. Published by Elsevier Inc.