Usefulness of the Combination of In-Hospital Poor Diuretic Response and Systemic Congestion to Predict Future Cardiac Events in Patients With Acute Decompensated Heart Failure

2017 ◽  
Vol 119 (12) ◽  
pp. 2010-2016 ◽  
Author(s):  
Soichiro Aoki ◽  
Takahiro Okumura ◽  
Akinori Sawamura ◽  
Katsuhide Kitagawa ◽  
Ryota Morimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiac Events ◽  
Diuretic Response

Abstract 12346: Reduced Diuretic Response With Fluid Retention is a Poor Prognostic Factor in Patients With Acute Decompensated Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Soichiro Aoki ◽  
Takahiro Okumura ◽  
Masaki Sakakibara ◽  
Akinori Sawamura ◽  
Ryota Morimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Factor ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Fluid Retention ◽  
Cardiac Events ◽  
Poor Prognostic Factor ◽  
Diuretic Response ◽  
Leg Edema ◽  
Group B

Introduction: Diuretic response (DR) has been proposed as a prognostic factor in heart failure patients. The presence of leg edema or jugular venous distention reflects fluid retention (FR) and patients are treated with diuretics under the guide of FR. However, the prognostic value of DR and FR has not been clarified. The aim of this study was to investigate the relation of DR and FR to the mortality in patients with acute decompensated heart failure. Methods: We enrolled 188 consecutive acute heart failure inpatients survived to discharge (mean age of 78 years, 101 females). DR was calculated by the formula; in-hospital Δbody weight kg / 80mg oral furosemide (or equivalent loop diuretic dose). FR on admission was simply evaluated by the presence of leg edema or jugular venous distention. All patients were divided into 4 groups based on the median of DR and FR; Group-A (DR≤-0.49 with FR, n=65), Group-B (DR≤-0.49 without FR, n=29), Group-C (DR>-0.49 with FR, n=47) and Group-D (DR>-0.49 without FR, n=47). We followed all patients up to one year after discharge. Cardiac events were defined as cardiac deaths and re-hospitalization for worsening heart failure. Results: The mean of LVEF was 44% and plasma BNP level was 960 pg/mL. The median length of stay was 18 days, the dose of furosemide was 570 mg, and the Δbody weight was -3.6 kg. The blood urea nitrogen level (p=0.001), creatinine level (p=0.004) and the prior exposure to loop diuretics (p<0.001) was significantly higher in the Group-C and D. The probability of cardiac events in the Group-C was significantly higher than that in any other groups (Figure). Adjusted multivariate analysis identified the Group-C as an independent predictor of cardiac events (HR: 2.32; 95% CI: 1.43-3.78; p=0.001). Conclusion: Reduced DR with FR is a poor prognostic factor in patients with acute decompensated heart failure.

scholarly journals Prognostic significance of cardiac I-123-metaiodobenzylguanidine imaging in patients with reduced, mid-range, and preserved left ventricular ejection fraction admitted for acute decompensated heart failure: a prospective study in Osaka Prefectural Acute Heart Failure Registry (OPAR)

2020 ◽  
Vol 22 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Masahiro Seo ◽  
Takahisa Yamada ◽  
Shunsuke Tamaki ◽  
Tetsuya Watanabe ◽  
Takashi Morita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mibg Imaging ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Abstract Aims Cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging provides prognostic information in patients with chronic heart failure (HF). However, there is little information available on the prognostic role of cardiac 123I-MIBG imaging in patients admitted for acute decompensated heart failure (ADHF), especially relating to reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) &lt; 40%], mid-range ejection fraction (HFmrEF; 40% ≤ LVEF &lt; 50%) and preserved ejection fraction (HFpEF; LVEF ≥ 50%). Methods and results We studied 349 patients admitted for ADHF and discharged with survival. Cardiac 123I-MIBG imaging, echocardiography, and venous blood sampling were performed just before discharge. The cardiac 123I-MIBG heart-to-mediastinum ratio (late H/M) was measured on the chest anterior view images obtained at 200 min after the isotope injection. The endpoint was cardiac events defined as unplanned HF hospitalization and cardiac death. During a follow-up period of 2.1 ± 1.4 years, 128 patients had cardiac events (45/127 in HFrEF, 28/78 in HFmrEF, and 55/144 in HFpEF). On multivariable Cox analysis, late H/M was significantly associated with cardiac events in overall cohort (P = 0.0038), and in subgroup analysis of each LVEF subgroup (P = 0.0235 in HFrEF, P = 0.0119 in HFmEF and P = 0.0311 in HFpEF). Kaplan–Meier analysis showed that patients with low late H/M (defined by median) had significantly greater risk of cardiac events in overall cohort (49% vs. 25% P &lt; 0.0001) and in each LVEF subgroup (HFrEF: 48% vs. 23% P = 0.0061, HFmrEF: 51% vs. 21% P = 0.0068 and HFpEF: 50% vs. 26% P = 0.0026). Conclusion Cardiac sympathetic nerve dysfunction was associated with poor outcome in ADHF patients irrespective of HFrEF, HFmrEF, or HFpEF.

scholarly journals Long-Term Effects and Prognosis in Acute Heart Failure Treated with Tolvaptan: The AVCMA Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Satoshi Suzuki ◽  
Akiomi Yoshihisa ◽  
Takayoshi Yamaki ◽  
Koichi Sugimoto ◽  
Hiroyuki Kunii ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Protective Effects ◽  
Long Term Effects ◽  
Cardiac Events ◽  
Sodium Potassium ◽  
Kaplan Meier ◽  
One Year

Background.Diuresis is a major therapy for the reduction of congestive symptoms in acute decompensated heart failure (ADHF) patients. We previously reported the efficacy and safety of tolvaptan compared to carperitide in hospitalized patients with ADHF. There were some reports of cardio- and renal-protective effects in carperitide; therefore, the purpose of this study was to compare the long-term effects of tolvaptan and carperitide on cardiorenal function and prognosis.Methods and Results.One hundred and five ADHF patients treated with either tolvaptan or carperitide were followed after hospital discharge. Levels of plasma B-type natriuretic peptide, serum sodium, potassium, creatinine, and estimated glomerular filtration rate were measured before administration of tolvaptan or carperitide at baseline, the time of discharge, and one year after discharge. These data between tolvaptan and carperitide groups were not different one year after discharge. Kaplan-Meier survival curves demonstrated that the event-free rate regarding all events, cardiac events, all cause deaths, and rehospitalization due to worsening heart failure was not significantly different between tolvaptan and carperitide groups.Conclusions.We demonstrated that tolvaptan had similar effects on cardiac and renal function and led to a similar prognosis in the long term, compared to carperitide.

scholarly journals Impact of polypharmacy on prognosis in patients with acute decompensated heart failure: from the CURE-HF registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Kanai ◽  
H Motoki ◽  
T Okano ◽  
K Kimura ◽  
M Minamisawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Cohort ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Funding Sources

Abstract Background Polypharmacy would be associated with poor prognosis in patients with heart failure (HF). Methods In 863 patients who discharged after treatment for HF were prospectively enrolled. Number of tablets prescribed at discharge was counted. Death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for HF were tracked. Results In our study cohort (median age, 78), 447 patients experienced adverse events during median 503 days follow-up. In Kaplan-Meier analysis, a greater number of prescribed tablets was associated with future adverse cardiac events in the crude population. Although patients with the greater number of non-HF medications showed worse outcome, those of HF medications were not associate with the outcome (Figure). Furthermore, the number of tablets was an independent predictor of future cardiovascular events after adjustment for age, gender, B-type natriuretic peptide, hemoglobin, albumin, estimated glomerular filtration rate, and left ventricular ejection fraction (HR 95% CI: 1.295 (1.066–1.573), p=0.009). Conclusions Polypharmacy was associated with poor prognosis. Although the numbers of tablets and non-HF medications were significantly associated with worse out come in HF patients, the number of HF medications was not. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Effects of Metolazone Administration on Congestion, Diuretic Response and Renal Function in Patients with Advanced Heart Failure

2021 ◽  
Vol 10 (18) ◽  
pp. 4207
Author(s):  
Alberto Palazzuoli ◽  
Gaetano Ruocco ◽  
Paolo Severino ◽  
Luigi Gennari ◽  
Filippo Pirrotta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Decompensated Heart Failure ◽  
Nyha Class ◽  
Decompensated Heart Failure ◽  
Advanced Heart Failure ◽  
Loop Diuretics ◽  
Reduced Ejection Fraction ◽  
Diuretic Response

Background: Advanced heart failure (HF) is a condition often requiring elevated doses of loop diuretics. Therefore, these patients often experience poor diuretic response. Both conditions have a detrimental impact on prognosis and hospitalization. Aims: This retrospective, multicenter study evaluates the effect of the addition of oral metolazone on diuretic response (DR), clinical congestion, NTproBNP values, and renal function over hospitalization phase. Follow-up analysis for a 6-month follow-up period was performed. Methods: We enrolled 132 patients with acute decompensated heart failure (ADHF) in advanced NYHA class with reduced ejection fraction (EF < 40%) taking a mean furosemide amount of 250 ± 120 mg/day. Sixty-five patients received traditional loop diuretic treatment plus metolazone (Group M). The mean dose ranged from 7.5 to 15 mg for one week. Sixty-seven patients continued the furosemide (Group F). Congestion score was evaluated according to the ESC recommendations. DR was assessed by the formula diuresis/40 mg of furosemide. Results: Patients in Group M and patients in Group F showed a similar prevalence of baseline clinical congestion (3.1 ± 0.7 in Group F vs. 3 ± 0.8 in Group M) and chronic kidney disease (CKD) (51% in Group M vs. 57% in Group F; p = 0.38). Patients in Group M experienced a better congestion score at discharge compared to patients in Group F (C score: 1 ± 1 in Group M vs. 3 ± 1 in Group F p > 0.05). Clinical congestion resolution was also associated with weight reduction (−6 ± 2 in Group M vs. −3 ± 1 kg in Group F, p < 0.05). Better DR response was observed in Group M compared to F (940 ± 149 mL/40 mgFUROSEMIDE/die vs. 541 ± 314 mL/40 mgFUROSEMIDE/die; p < 0.01), whereas median ΔNTproBNP remained similar between the two groups (−4819 ± 8718 in Group M vs. −3954 ± 5560 pg/mL in Group F NS). These data were associated with better daily diuresis during hospitalization in Group M (2820 ± 900 vs. 2050 ± 1120 mL p < 0.05). No differences were found in terms of WRF development and electrolyte unbalance at discharge, although Group M had a significant saline solution administration during hospitalization. Follow-up analysis did not differ between the group but a reduced trend for recurrent hospitalization was observed in the M group (26% vs. 38%). Conclusions: Metolazone administration could be helpful in patients taking an elevated loop diuretics dose. Use of thiazide therapy is associated with better decongestion and DR. Current findings could suggest positive insights due to the reduced amount of loop diuretics in patients with advanced HF.

P5406Impact of the albumin level on the prognostic value of diuretic response in patients admitted for acute decompensated heart failure: a prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Yamamoto ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
S Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Albumin Level ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diuretic Response ◽  
Cox Analysis ◽  
The Impact

Abstract Background The reduced diuretic response (DR) has been shown to be associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). In addition, hypoalbuminemia, which is related to DR, has been also reported to predict poor prognosis in ADHF patients. However, there is no information available on the impact of albumin level on the prognostic value of DR in patients with ADHF. Methods We prospectively studied 296 consecutive patients who were admitted for ADHF and survived to discharge. The patients were divided into 2 groups according to the presence or absence of hypoalbuminemia at the admission, defined as the serum level of albumin at admission <3.5g/dl, and DR was defined as weight loss per 40mg intravenous dose and 80mg oral dose of furosemide up to day 4. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure. Results There were 144 patients with hypoalbuminemia and 152 patients without hypoalbuminemia. During a mean follow-up period of 2.2±1.5 years, 88 patients with hypoalbuminemia and 53 patients without hypoalbuminemia reached the endpoint. In group with hypoalbuminemia, DR was significantly smaller in patients with than without the endpoint (0.85 [0.50–1.50] vs 1.60 [0.76–2.70] kg/40mg furosemide, p=0.003), while there was no significant difference in DR between them in group without hypoalbuminemia (1.17 [0.59–1.66] vs 1.07 [0.75–1.88] kg/40mg furosemide, p=0.381). At multivariate Cox analysis, in group with hypoalbuminemia, DR was significantly associated with the endpoint, independently of age, left ventricular ejection fraction, and serum creatinine and plasma BNP levels. On the other hand, in group without hypoalbuminemia, DR showed no significant association with the endpoint at univariate Cox analysis. Kaplan-Meier analysis showed that patients with poor DR (≤1.08 kg/40mg furosemide: median value) had a significantly higher risk of the endpoint in group with hypoalbuminemia, but not in group without hypoalbuminemia (Figure). Figure 1 Conclusion Our results suggested that prognostic value of DR in ADHF patients is affected by the presence or absence of hypoalbuminemia.

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