Renal impairment and worsening of renal function in acute heart failure: can new therapies help? The potential role of serelaxin

2015 ◽  
Vol 104 (8) ◽  
pp. 621-631 ◽  
Author(s):  
Roland E. Schmieder ◽  
Veselin Mitrovic ◽  
Christian Hengstenberg
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Impairment ◽  
Acute Heart Failure ◽  
Potential Role ◽  
New Therapies

scholarly journals Complement activation products in acute heart failure: Potential role in pathophysiology, responses to treatment and impacts on long-term survival

2017 ◽  
Vol 7 (4) ◽  
pp. 348-357 ◽  
Author(s):  
Marten Trendelenburg ◽  
Fabio Stallone ◽  
Kateryna Pershyna ◽  
Timo Eisenhut ◽  
Raphael Twerenbold ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Complement Activation ◽  
Subgroup Analysis ◽  
Potential Role ◽  
Control Group ◽  
Term Survival ◽  
Activation Products

Background: Previous studies have indicated a correlation between heart failure, inflammation and poorer outcome. However, the pathogenesis and role of inflammation in acute heart failure (AHF) is incompletely studied and understood. The aim of our study was to explore the potential role of innate immunity – quantified by complement activation products (CAPs) – in pathophysiology, responses to treatment and impacts on long-term survival in AHF. Methods: In a prospective study enrolling 179 unselected patients with AHF, plasma concentrations of C4d, C3a and sC5b-9 were measured in a blinded fashion on the first day of hospitalisation and prior to discharge. The final diagnosis, including the AHF phenotype, was adjudicated by two independent cardiologists. Long-term follow-up was obtained. Findings in AHF were compared to that obtained in 75 healthy blood donors (control group). Results: Overall, concentrations of all three CAPs were significantly higher in patients with AHF than in healthy controls (all p < 0.001). In an age-adjusted subgroup analysis, significant differences could be confirmed for concentrations of C4d and sC5b-9, and these parameters further increased after 6 days of in-hospital treatment ( p < 0.001). In contrast, C3a levels in AHF patients did not differ from those of the control group in the age-adjusted subgroup analysis and remained constant during hospitalisation. Concentrations of C4d, C3a and sC5b-9 were significantly higher when AHF was triggered by an infection as compared to other triggers ( p < 0.001). In addition, CAP levels significantly correlated with each other ( r = 0.64–0.76), but did not predict death within 2 years. Conclusions: Activation of complement with increased plasma levels of C4d and sC5b-9 at admission and increasing levels during AHF treatment seems to be associated with AHF, particularly when AHF was triggered by an infection. However, CAPs do not have a prognostic value in AHF.

scholarly journals 573 Different renal function patterns in acute heart failure patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gaetano Ruocco ◽  
Mauro Feola ◽  
Lorenzo Luschi ◽  
Angelica Brazzi ◽  
Nicolo Ghionzoli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Permanent Improvement ◽  
Transient Improvement ◽  
Causes Of Mortality ◽  
Post Hoc

Abstract Aims The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements. The aim of this study is to investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients. Methods and results This is a post hoc analysis of a multi-centres study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behaviour: according to the RF curve our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization. We recruited 467 subjects with a mean congestion score of 3.5 ± 1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2, and NTpro BNP 7000 (4200–11 700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); P &lt; 0.001; HR: 1.68 (1.15–2.45); P = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR: 0.34 (0.19–0.60); P &lt; 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); P &lt; 0.001 and HR: 0.47 (0.35–0.67); P &lt; 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion, and reduced BNP decrease at discharge. Conclusions Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.

scholarly journals Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Pedro Caravaca Pérez ◽  
Jorge Nuche ◽  
Laura Morán Fernández ◽  
David Lora ◽  
Zorba Blázquez-Bermejo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Potential Role ◽  
Stress Test ◽  
Adverse Outcomes ◽  
Sample Median ◽  
Diuretic Treatment ◽  
Diuretic Response ◽  
Worse Prognosis

Background: Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization. Methods: Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0–9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST. Results: Median UNa after FST in the 65 patients included was 113 (97–122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P =0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa; P <0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months. Conclusions: Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.

scholarly journals 572 Different renal function patterns in acute heart failure patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gaetano Ruocco ◽  
Mauro Feola ◽  
Lorenzo Luschi ◽  
Angelica Brazzi ◽  
Nicolo Ghionzoli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Permanent Improvement ◽  
Transient Improvement ◽  
Causes Of Mortality ◽  
Post Hoc

Abstract Aims The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements. The aim of this study is to investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients. Methods and results This is a post hoc analysis of a multi-centres study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behaviour: according to the RF curve our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization. We recruited 467 subjects with a mean congestion score of 3.5 ± 1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2, and NTpro BNP 7000 (4200–11 700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); P &lt; 0.001; HR: 1.68 (1.15–2.45); P = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR: 0.34 (0.19–0.60); P &lt; 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); P &lt; 0.001 and HR: 0.47 (0.35–0.67); P &lt; 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion and reduced BNP decrease at discharge. Conclusions Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.

scholarly journals The prognostic role of different renal function phenotypes in patients with acute heart failure

2019 ◽  
Vol 276 ◽  
pp. 198-203 ◽  
Author(s):  
Alberto Palazzuoli ◽  
Gaetano Ruocco ◽  
Pierpaolo Pellicori ◽  
Eufemia Incampo ◽  
Cristina Di Tommaso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Prognostic Role

Response by Caravaca Pérez et al to Letter Regarding Article, “Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure”

2021 ◽  
Author(s):  
Pedro Caravaca Pérez ◽  
Jorge Nuche ◽  
Juan Carlos López-Azor ◽  
Rafael Salguero-Bodes ◽  
Fernando Arribas Ynsaurriaga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Potential Role ◽  
Stress Test
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