scholarly journals Natriuresis guided therapy in acute heart failure: rationale and design of the Pragmatic Urinary Sodium‐based Treatment algoritHm in Acute Heart Failure ( PUSH‐AHF ) trial

2021 ◽  
Author(s):  
Jozine M. ter Maaten ◽  
Iris E. Beldhuis ◽  
Peter van der Meer ◽  
Jan A. Krikken ◽  
Jenifer E. Coster ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Treatment Algorithm ◽  
Urinary Sodium ◽  
Guided Therapy

Early Spot Urinary Sodium and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction

2020 ◽  
Vol 10 (5) ◽  
pp. 362-372
Author(s):  
Gema Miñana ◽  
Pau Llàcer ◽  
Ignacio Sanchis ◽  
Sergio García-Blas ◽  
Clara Bonanad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Linear Regression Analysis ◽  
Urinary Sodium ◽  
Coefficient Of Determination ◽  
Multivariate Linear Regression Analysis ◽  
Early Assessment ◽  
Diuretic Efficiency ◽  
Glomerular Filtrate

Objective: In acute heart failure (AHF), early assessment of spot urinary sodium (UNa) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot UNa predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot UNa in patients with AHF and concomitant renal dysfunction (RD). Methods: This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] <60 mL/min/1.73 m2) were included. Diuretic efficiency was calculated as the net fluid output produced per 40 mg of furosemide equivalents in 24 h. The association between early spot UNa and diuretic efficiency and clinical variables associated with UNa were evaluated using multivariate linear regression analysis. The contribution of the exposures in the predictability of the models was assessed with the coefficient of determination (R2). Results: The mean age of the study population was 78 ± 8 years. The median (interquartile range) diuretic efficiency, early spot UNa, aminoterminal pro-brain natriuretic peptide, and eGFR were 747 (490–1,167) mL, 90 mmol/L (65–111), 7,765 pg/mL (3,526–15,369), and 33.7 ± 11.3 mL/min/1.73 m2, respectively. In a multivariate setting, lower UNa was significantly and nonlinearly associated with lower diuretic efficiency (p = 0.001), explaining the 44.4% of the model predictability. Natremia and surrogates of congestion emerged as the main factors related to UNa. Conclusions: In patients with AHF and RD at presentation, early spot UNa was inversely related to 24-h diuretic efficiency.

scholarly journals Urinary sodium evaluation: the missing target for diuretic treatment optimization in acute heart failure patients? Reply

2020 ◽  
Vol 22 (10) ◽  
pp. 1933-1934
Author(s):  
Kevin Damman ◽  
Jozine M. Ter Maaten ◽  
Peter Meer
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Urinary Sodium ◽  
Treatment Optimization ◽  
Diuretic Treatment ◽  
Heart Failure Patients

N-terminal pro-B-type natriuretic peptide-guided therapy in patients hospitalized for acute heart failure

2016 ◽  
Vol 17 (11) ◽  
pp. 828-839 ◽  
Author(s):  
Valentina Carubelli ◽  
Carlo Lombardi ◽  
Valentina Lazzarini ◽  
Ivano Bonadei ◽  
Anna I. Castrini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Guided Therapy

scholarly journals Clinical importance of urinary sodium excretion in acute heart failure

2020 ◽  
Vol 22 (8) ◽  
pp. 1438-1447 ◽  
Author(s):  
Kevin Damman ◽  
Jozine M. Ter Maaten ◽  
Jenifer E. Coster ◽  
Jan A. Krikken ◽  
Vincent M. Deursen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Sodium Excretion ◽  
Clinical Importance ◽  
Urinary Sodium Excretion ◽  
Urinary Sodium

Prognostic Effect of Carbohydrate Antigen 125-guided Therapy in Patients Recently Discharged for Acute Heart Failure (CHANCE-HF). Study Design

2015 ◽  
Vol 68 (2) ◽  
pp. 121-128
Author(s):  
Julio Núñez ◽  
Pilar Merlos ◽  
Lorenzo Fácila ◽  
Pau Llàcer ◽  
Maria José Bosch ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Study Design ◽  
Carbohydrate Antigen ◽  
Carbohydrate Antigen 125 ◽  
Prognostic Effect ◽  
Guided Therapy

scholarly journals Management of the Patient with Heart Failure and an Implantable Pulmonary Artery Hemodynamic Sensor

2020 ◽  
Vol 14 (9) ◽  
Author(s):  
Jacob Abraham ◽  
◽  
Patrick J. McCann ◽  
Maya E. Guglin ◽  
Arvind Bhimaraj ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Treatment Algorithm ◽  
Sensor Technology ◽  
Published Data ◽  
Efficiency And Effectiveness ◽  
Practical Guidelines ◽  
Vascular Physiology ◽  
Monitoring Platform ◽  
Guided Therapy

Abstract Purpose of Review Heart failure (HF) management guided by hemodynamics obtained from an implantable pulmonary artery pressure (PAP) sensor (CardioMEMS) improves symptoms and reduces HF hospitalizations (HFH). This paper reviews the theoretical basis of pulmonary vascular physiology, summarizes recently published data about CardioMEMS, and provides practical guidelines for patient selection and management. Recent Findings Compared to patients managed by standard care, HF patients randomized to PAP-guided treatment have a higher frequency of medication adjustments, resulting in lower PAP and fewer HFH. Real-world analyses further support associations between implant of the CardioMEMS sensor with reductions in PAP, hospitalizations, and mortality. Summary Implantable, wireless hemodynamic sensor technology is a promising remote monitoring platform for chronic HF. A phased approach using a treatment algorithm may improve the efficiency and effectiveness of pressure-guided therapy.

Abstract 15217: Combination Phosphodiesterase V Inhibition and Low Dose B-type Natriuretic Peptide Did Not Enhance Renal Function in Acute Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Scott Hubers ◽  
sherry benike ◽  
Christopher Scott ◽  
Bradley Johnson ◽  
Horng Chen
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Low Dose ◽  
Study Drug ◽  
Cyclic Guanosine Monophosphate ◽  
Urinary Sodium ◽  
Guanosine Monophosphate ◽  
Open Label

Introduction: Cardiorenal dysfunction with impaired cyclic guanosine monophosphate (cGMP) response to volume load is a hallmark of heart failure. Phosphodiesterase V (PDEV) is known to be upregulated and may explain the dysfunction of renal response. Hypothesis: We tested the hypothesis that PDEV inhibition in combination with low dose intravenous (IV) B-type natriuretic peptide (BNP) would improve renal function and potentiate urinary sodium and cGMP excretion in patients with acute heart failure. Methods: Randomized open label study in 67 patients admitted to the hospital with acute heart failure. These patients were randomized to standard care, low dose IV BNP (0.005μg/kg/min), or combination low dose BNP/PDEV inhibition with sildenafil (25 mg q12 hrs) for 48 hours. Plasma and urine studies were obtained at baseline, 24 hours, and 48 hours after study drug initiation to assess renal function. The primary endpoint was the percent change in estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) from baseline to 48 hours. Changes from baseline were summarized with median and quartiles and groups were compared using two-sample t-test. [ClinicalTrials.gov Identifier: NCT00972569] Results: Baseline characteristics were similar between groups. Median age was 78 years and median ejection fraction 39%. Treatment with BNP and BNP/PDEV inhibitor significantly increased plasma cGMP at 24 hr (% increase of 25.6 (8.9, 13.1) and 60.8 (32.3, 103.8) for BNP and BNP/PDEV vs % decrease of 13.5 (-29.1, 14.2) for placebo, p=0.001). BNP levels were significantly higher in both groups at 48 hr compared with placebo. However, there was no significant change in eGFR, BUN, or urinary sodium/cGMP excretion between groups. Hypotension was more common in the BNP/PDEV inhibitor group. Conclusions: Low dose IV BNP and combination BNP/PDEV inhibition increased plasma cGMP in patients with acute heart failure but did not improve renal function or urinary sodium/cGMP excretion. Our study does not support the use of low dose IV BNP with or without PDEV inhibition to enhance renal function in patients admitted with acute heart failure.

Long-term prognostic significance of urinary sodium concentration in patients with acute heart failure

2018 ◽  
Vol 254 ◽  
pp. 189-194 ◽  
Author(s):  
Satoshi Honda ◽  
Toshiyuki Nagai ◽  
Kunihiro Nishimura ◽  
Michikazu Nakai ◽  
Yasuyuki Honda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Prognostic Significance ◽  
Sodium Concentration ◽  
Urinary Sodium

Early urinary sodium trajectory and risk of adverse outcomes in acute heart failure and renal dysfunction

2020 ◽  
Author(s):  
Rafael de la Espriella ◽  
Eduardo Núñez ◽  
Pau Llàcer ◽  
Sergio García-Blas ◽  
Silvia Ventura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Adverse Outcomes ◽  
Urinary Sodium
Sign in / Sign up

Export Citation Format

Share Document