Abstract:
Background. Renal dysfunction substantially worsens the prognosis of patients with heart failure (HF). Endothelial glycocalyx degradation has recently emerged as a key mechanism underlying cardiorenal syndrome, while syndecan-1 has gained attention as a circulating biomarker of endothelial injury. However, its relationship with renal dysfunction and cardiac hemodynamics in HF remains insufficiently characterized.
Objective. To evaluate the association between serum syndecan-1 concentrations and cystatin C-based renal function, cardiac hemodynamic parameters, inflammatory biomarkers, and to determine its diagnostic value for the early detection of renal dysfunction in patients with chronic heart failure (CHF).
Methods. This prospective observational study included 100 patients with New York Heart Association (NYHA) class II-III CHF and 32 age- and sex-matched healthy controls. Renal function was assessed using cystatin C-based estimated glomerular filtration rate (eGFR), and patients were stratified into two groups (eGFR 60-89 and ≥90 mL/min/1.73 m²). Serum syndecan-1, N-terminal pro-B-type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and echocardiographic parameters were evaluated. Correlation and receiver operating characteristic (ROC) analyses were performed.
Results. Serum syndecan-1 concentrations were significantly higher in patients with reduced renal function than in those with preserved renal function (103.3±2.02 vs. 71.1±0.55 ng/mL, P<0.001). Syndecan-1 showed strong positive correlations with cystatin C (r=0.67), IL-6 (r=0.58), NT-proBNP (r=0.59), and E/e' ratio (r=0.44), and inverse correlations with eGFR (r=-0.65) and left ventricular ejection fraction (r=-0.42) (all P<0.01). ROC analysis demonstrated excellent diagnostic performance for identifying early renal dysfunction (AUC=0.898), with an optimal cutoff value of 78.3 ng/mL, sensitivity of 88.0%, and specificity of 92.0%.
Conclusions. Syndecan-1 is strongly associated with renal impairment, endothelial injury, inflammation, and cardiac dysfunction in CHF. Its excellent diagnostic accuracy suggests that syndecan-1 may serve as a valuable adjunctive biomarker for the early detection of cardiorenal syndrome and improved risk stratification in patients with chronic heart failure.
