Abstract
Background. The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes. Methods: Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events. Results: 263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function (p = 0.001), a higher NT-proBNP (p = 0.001), a lower left ventricular ejection fraction (p = 0.01), DR (p = 0.02) and R-to-D (p = 0.03). Spearman rho’s correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; p < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; p < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; p < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome (p = 0.04 and p = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = −0.23; p = 0.01). Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.
Highlights
In heart failure (HF) patients the evaluation of prognosis is currently performed on multiple clinical and laboratory variables, but it remains unpredictable because of sudden hemodynamic deterioration related to cardiac and extracardiac reasons and the lack of consistent universally validated algorithm [1]
Patients with symptoms of congestive heart failure (CHF), plasma NT-proBNP > 125 pg/mL, left ventricular ejection fraction (LVEF) > 50% and diastolic dysfunction were defined as HF preserved ejection fraction (HFpEF)
R-to-D was inversely related to in-hospital stay (r = −0.23; p = 0.01)
Summary
In heart failure (HF) patients the evaluation of prognosis is currently performed on multiple clinical and laboratory variables, but it remains unpredictable because of sudden hemodynamic deterioration related to cardiac and extracardiac reasons and the lack of consistent universally validated algorithm [1]. The presence of renal dysfunction and arterial hypotension may stratify patients with the worst clinical outcome after discharging for an acute decompensated heart failure episode [2]. A worse diuretic response (the lowest quintiles corresponded to the worst prognosis) was independently correlated with 180-day mortality (HR 1.42), 60-day death or renal or cardiovascular rehospitalization (HR 1.34) and 60-day rehospitalization (HR 1.57). These data represented a robust indicator that a blunted loss in weight in CHF patients admitted for acute decompensation described a “diuretic resistance”. The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
