Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis
Por:
Marcos, MC, de la Espriella, R, Zegri-Reiriz, I, Llacer, P, Gracia, JR, Comín-Colet, J, Morales-Rull, JL, Diez-Villanueva, P, Baguda, JD, Jimenez-Marrero, S, Cortés, CO, Restrepo-Córdoba, MA, García-Pinilla, JM, Barrios, E, Díaz, SD, Núñez, J
Publicada:
1 ago 2025
Ahead of Print:
1 mar 2025
Resumen:
Aims Early diuresis and natriuresis are commonly used to assess the efficacy of decongestive therapy following an acute heart failure episode. There is limited knowledge regarding which parameter better predicts adverse clinical outcomes, especially in the outpatient setting. This study investigated the prognostic value of both metrics in predicting 30-day adverse clinical events in an ambulatory worsening heart failure (WHF) scenario. Methods and results This is a post-hoc analysis of the SALT-HF trial involving 167 patients with ambulatory WHF randomized to receive intravenous furosemide with or without hypertonic saline solution. Early diuretic response was assessed through 3-h urine output and 3-h urinary sodium (uNa+) levels following intravenous (IV) diuretic infusion. We analysed their association with 30-day adverse events (defined as death, heart failure hospitalization, or the need for outpatient IV diuretics) using logistic regression analysis. Both exposures were examined along the continuum and dichotomized in their median. The discriminative ability between the exposures and endpoints was assessed by receiver operating characteristic curves (AUC-ROC). Results The median age of participants was 81 years, predominantly male (69.5%). Patients with lower 3-h urinary sodium and diuresis were older and exhibited reduced kidney function and haemoglobin levels. At 30 days, 50 (29.9%) of the sample experienced the composite endpoint. Multivariate analyses revealed that lower 3-h uNa+ was associated with a higher risk of 30-day adverse events (P = 0.008). Conversely, 3-h diuresis did not significantly predict 30-day adverse outcomes (P = 0.424). There was a trend towards a higher AUC-ROC for the inverse of 3-h natriuresis compared with 3-h diuresis: 0.680 versus 0.601, P = 0.092. Conclusions In patients with ambulatory WHF treated with IV furosemide, 3-h urinary sodium predicted 30-day outcomes whereas 3-h diuresis did not.
Filiaciones:
Marcos, MC:
Hosp Univ Puerta Hierro, Dept Cardiol, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
de la Espriella, R:
Univ Valencia, Radiol Dept, Hosp Clin Univ Valencia, Valencia, Spain
Zegri-Reiriz, I:
Hosp Santa Creu & Sant Pau, Dept Pathol, Barcelona, Spain
Llacer, P:
Hosp Univ Ramon & Cajal, IRYCIS, Dept Internal Med, Madrid, Spain
Univ Alcala, Fac Med & Ciencias Salud, Dept Med & Med Specialties, Madrid, Spain
Gracia, JR:
Lozano Blesa Univ Clin Hosp, Aragon Inst Hlth Res IIS Aragon, Radiol Intervencionista, Zaragoza, Spain
Comín-Colet, J:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Hosp Univ Bellvitge, IDIBELL, Dept Cardiol, Barcelona, Spain
Morales-Rull, JL:
Univ Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLLEIDA, Lleida Hlth Reg, Dept Internal Med,Heart Failure Unit, Lleida, Spain
Diez-Villanueva, P:
Hosp Univ Princesa, Dept Cardiol, Madrid, Spain
Baguda, JD:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Hosp 12 Octubre, Inst Invest Sanitaria Hosp Octubre 12 imas12, Dept Cardiol, Madrid, Spain
Univ Europea Madrid, Fac Biomed & Hlth Sci, Dept Med, Madrid, Spain
Jimenez-Marrero, S:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Lozano Blesa Univ Clin Hosp, Aragon Inst Hlth Res IIS Aragon, Radiol Intervencionista, Zaragoza, Spain
Cortés, CO:
Hosp Univ San Pedro de Alcantara, Dept Pathol, Caceres, Spain
Restrepo-Córdoba, MA:
Hosp Univ Clin San Carlos, Dept Cardiol, Madrid, Spain
García-Pinilla, JM:
Hosp Univ Virgen Victoria, Dept Cardiol, Malaga, Spain
Univ Malaga, Inst Salud Carlos 3, Inst InvestigacionBiomed Plataforma BIONAND Malaga, Dept Med & Dermatol, Malaga, Spain
Barrios, E:
Hosp Univ Rey Juan Carlos Mostoles, Dept Cardiol, Madrid, Spain
Díaz, SD:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Hosp Univ Ramon & Cajal, Dept Cardiol, Madrid, Spain
Núñez, J:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Valencia, Radiol Dept, Hosp Clin Univ Valencia, Valencia, Spain
Green Submitted, gold
|