Admission Circulating microRNAs and Residual Congestion in Very Elderly Patients With Acute Decompensated Heart Failure: Associations With miR-223-3p and miR-423-5p.

Residual congestion at 48 hours was present in nearly half of the patients with acute decompensated heart failure.

• Residual congestion occurred in 69 of 145 patients (47.6%).
• It was defined as at least 2 of 3 criteria: VExUS score ≥ 1, clinical congestion score ≥ 3, or NT-proBNP ratio ≥ 0.70.
• Seven admission serum miRNAs were quantified by RT-qPCR in the cohort of 145 adults.

Higher admission miR-223-3p expression was associated with lower odds of residual congestion at 48 hours.

• In complete-case models (n = 119), the adjusted OR was 0.57 (95% CI, 0.36-0.91).
• Logistic regression models were used to assess residual congestion.
• The authors describe miR-223-3p as showing the more consistent exploratory association with early residual congestion.

Higher admission miR-423-5p expression was associated with higher odds of residual congestion at 48 hours, but the evidence was less robust.

• In complete-case models (n = 119), the adjusted OR was 1.54 (95% CI, 1.00-2.38).
• The confidence interval's lower bound is at 1.00, and the authors characterize the evidence for miR-423-5p as less robust than for miR-223-3p.

Neither miR-223-3p nor miR-423-5p was independently associated with intravenous loop-diuretic dose intensity.

• Diuretic dose intensity was assessed using robust log-linear models.
• The study examined associations of the miRNAs with both residual congestion and diuretic treatment intensity.

The associations are exploratory and require external validation before any clinical use.

• The study was conducted in a single cohort of 145 very elderly adults with ADHF, with complete-case models limited to 119 patients.
• The authors conclude that external validation is required before clinical use.