Why the study?
Diuretic resistance indicates a phenotype of refractory heart failure, and this study aimed to differentiate diuretic-resistant from non-resistant patients to identify biomarkers linked to its emergence.
What serum metabolites can serve as biomarkers to differentiate diuretic-resistant from non-resistant heart failure patients?
What serum metabolites can serve as biomarkers to differentiate diuretic-resistant from non-resistant heart failure patients?
Metabolomic profiling identified five endogenous metabolites, including hydroxykynurenine and perillic acid, as potential biomarkers for diuretic resistance in heart failure.
Should not yet change DR diagnosis or management; leaves open whether this metabolomic panel can be validated for earlier detection of refractory HF.
Background: Diuretic resistance (DR) is characterized by insufficient fluid and sodium excretion enhancement despite maximum loop diuretic doses, indicating a phenotype of refractory heart failure (HF). Recently, metabolomics has emerged as a crucial tool for diagnosing and understanding the pathogenesis of various diseases. This study aimed to differentiate diuretic-resistant patients from non-resistant HF to identify biomarkers linked to the emergence of DR. Methods: Serum samples from HF patients, both with and without DR, were subjected to non-targeted metabolomic analysis using liquid chromatography-tandem mass spectrometry. Metabolite variations between groups were identified using principal component analysis and orthogonal partial least-square discriminant analysis. Metabolic pathways were assessed through the Kyoto Encyclopedia of Genes and Genomes database enrichment analysis, and potential biomarkers were determined using receiver operating characteristic curves (ROCs). Results: In total, 192 metabolites exhibited significant differences across the two sample groups. Among these, up-regulation was observed in 164 metabolites, while 28 metabolites were down-regulated. A total of 28 pathways involving neuroactive ligand-receptor interaction and amino acid biosynthesis were affected. The top five metabolites identified by ROC analysis as potential DR biomarkers were hydroxykynurenine, perillic acid, adrenic acid, 5-acetamidovalerate, and adipic acid. Conclusions: Significant differences in metabolite profiles were observed between the diuretic-resistant and non-diuretic-resistant groups among patients with HF. The top five differentially expressed endogenous metabolites were hydroxykynurenine, perillic acid, adrenic acid, 5-acetamidovalerate, and adipic acid. The metabolic primary pathways implicated in DR were noted as amino acid, energy, and nucleotide metabolism. Clinical Trial Registration: This study was registered with the China Clinical Trials Registry (https://www.chictr.org.cn/hvshowproject.html?id=197183&v=1.7, ChiCTR2100053587).
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Yi-pin et al. (2025) studied this question.
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