2024
The utility of urine sodium–guided diuresis during acute decompensated heart failure
Siddiqi H, Cox Z, Stevenson L, Damman K, ter Maaten J, Bales B, Han J, Ivey-Miranda J, Lindenfeld J, Miller K, Ooi H, Rao V, Schlendorf K, Storrow A, Walsh R, Wrenn J, Testani J, Collins S. The utility of urine sodium–guided diuresis during acute decompensated heart failure. Heart Failure Reviews 2024, 1-13. PMID: 39128947, DOI: 10.1007/s10741-024-10424-8.Peer-Reviewed Original ResearchAcute decompensated heart failureDecompensated heart failureHeart failureClinical trialsUrine sodium excretionObservational cohort studyRandomized clinical trialsAdequate decongestionDiuretic strategySodium excretionUrine chemistryCohort studyTitration strategyUrineDiuretic titrationAdverse effectsDiuresisDecongestionPatientsUsual careEvidence gapsTrialsTherapyFailureIncreased Spironolactone Dosing in Acute Heart Failure Alters Potassium Homeostasis but Does Not Enhance Decongestion
Natov P, Ivey-Miranda J, Cox Z, Rao V, Butler J, Konstam M, Kiernan M, Kapur N, Testani J. Increased Spironolactone Dosing in Acute Heart Failure Alters Potassium Homeostasis but Does Not Enhance Decongestion. Journal Of Cardiac Failure 2024 PMID: 38986838, DOI: 10.1016/j.cardfail.2024.06.008.Peer-Reviewed Original ResearchBaseline serum potassiumAcute heart failureSerum potassiumSpironolactone treatmentTreatment armsHeart failureBaseline serum potassium levelsNatriuretic peptide levelsTreated with spironolactoneSerum potassium levelsSpironolactone-treated patientsNet fluid lossRenal potassium handlingPost hoc analysisEnhance decongestionSpironolactone dosePotassium wastingUrine outputClinical congestionTreatment startPotassium handlingPotassium replacementPotassium supplementationPharmacodynamic effectsSurrogate markerPeak Tricuspid Regurgitation Jet Velocity and Kidney Outcomes in Patients With Heart Failure With Preserved Ejection Fraction
Oka T, Tighiouart H, McCallum W, Tuttle M, Testani J, Sarnak M. Peak Tricuspid Regurgitation Jet Velocity and Kidney Outcomes in Patients With Heart Failure With Preserved Ejection Fraction. Kidney International Reports 2024 DOI: 10.1016/j.ekir.2024.07.009.Peer-Reviewed Original ResearchLeft ventricular ejection fractionPulmonary artery pressureCreatinine doublingEGFR declineEjection fractionKidney outcomesHeart failurePeak tricuspid regurgitant jet velocityDoubling of serum creatinineTricuspid regurgitant jet velocityElevated pulmonary artery pressureAssociated with lower eGFRWorsening kidney functionVentricular ejection fractionRegurgitant jet velocityCox proportional hazards modelsProportional hazards modelPost hoc analysisBaseline eGFRSerum creatinineLow eGFRTOPCAT trialFollow-upKidney functionArterial pressureVolenrelaxin (LY3540378) increases renal plasma flow: a randomized Phase 1 trial
San Tham L, Heerspink H, Wang X, Verdino P, Saifan C, Benson E, Goldsmith P, Wang Z, Testani J, Haupt A, Sam F, Cherney D. Volenrelaxin (LY3540378) increases renal plasma flow: a randomized Phase 1 trial. Nephrology Dialysis Transplantation 2024, gfae112. PMID: 38782726, DOI: 10.1093/ndt/gfae112.Peer-Reviewed Original ResearchMeasured glomerular filtration rateEffective renal plasma flowRenal plasma flowKidney perfusionIncreased renal plasma flowPlacebo-adjusted changeMultiple-ascending dosePhase 1 trialGlomerular filtration rateChronic heart failureChronic kidney diseaseDiastolic blood pressureRenal arteriolar resistanceExtended half-lifeCardiorenal functionDouble-blindPlacebo SCRelaxin proteinSC doseAdverse eventsMeasured GFRArteriolar resistanceClinical developmentHeart failureOrthostatic hypotensionDietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC
Mullens W, Damman K, Dhont S, Banerjee D, Bayes‐Genis A, Cannata A, Chioncel O, Cikes M, Ezekowitz J, Flammer A, Martens P, Mebazaa A, Mentz R, Miró Ò, Moura B, Nunez J, Maaten J, Testani J, van Kimmenade R, Verbrugge F, Metra M, Rosano G, Filippatos G. Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC. European Journal Of Heart Failure 2024, 26: 730-741. PMID: 38606657, DOI: 10.1002/ejhf.3244.Peer-Reviewed Original ResearchConceptsHeart failureClinical consensus statementFluid restrictionDietary sodiumConsensus statementEuropean Society of Cardiology HF guidelinesUntreated patient cohortLimitation of salt intakeHeart Failure AssociationSodium handlingSodium intakePatient cohortSalt intakeHF guidelinesFluid intakeFailure AssociationFluid homeostasisPatientsAvidity stateEuropean SocietyIntakeHeartContemporary evidenceExpert opinionData challengeContemporary Decongestion Strategies in Patients Hospitalized for Heart Failure A National Community-Based Cohort Study
Zheng J, Ambrosy A, Bhatt A, Collins S, Flint K, Fonarow G, Fudim M, Greene S, Lala A, Testani J, Varshney A, Wi R, Sandhu A. Contemporary Decongestion Strategies in Patients Hospitalized for Heart Failure A National Community-Based Cohort Study. JACC Heart Failure 2024, 12: 1381-1392. PMID: 38678466, DOI: 10.1016/j.jchf.2024.04.002.Peer-Reviewed Original ResearchPredictors of weight lossHeart failureWeight lossHF hospitalizationPatient-level electronic health record dataCommunity-based health systemAssociated with less weight lossContinuous diuretic infusionsElectronic health record dataCommunity-based cohort studyAssociated with greater weight lossHealth record dataGreater weight lossBackground Heart failureEstimated weight lossLess weight lossAdjunctive diureticsDiuretic infusionAcute HFSerum creatinineClinical predictorsDecongestion strategiesAdmission weightStudy cohortDischarge weightSerial direct sodium removal in patients with heart failure and diuretic resistance
Rao V, Ivey‐Miranda J, Cox Z, Moreno‐Villagomez J, Ramos‐Mastache D, Neville D, Balkcom N, Asher J, Bellumkonda L, Bigvava T, Shaburishvili T, Bartunek J, Wilson F, Finkelstein F, Maulion C, Turner J, Testani J. Serial direct sodium removal in patients with heart failure and diuretic resistance. European Journal Of Heart Failure 2024, 26: 1215-1230. PMID: 38556717, DOI: 10.1002/ejhf.3196.Peer-Reviewed Original ResearchConceptsDiuretic resistanceCardiorenal syndromeHeart failureLoop diureticsDiuretic withdrawalHigh-dose loop diureticsN-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideGrowth differentiation factor 15Carbohydrate antigen 125Differentiation factor 15Sodium removalRandomized controlled studyCardiorenal parametersDiuretic doseSoluble ST2Natriuretic peptideMedian timeDiuretic responseKidney injuryPeritoneal membraneElectrolyte handlingKidney functionDiureticsInterleukin-6Integration of implantable device therapy in patients with heart failure. A clinical consensus statement from the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC)
Mullens W, Dauw J, Gustafsson F, Mebazaa A, Steffel J, Witte K, Delgado V, Linde C, Vernooy K, Anker S, Chioncel O, Milicic D, Hasenfuß G, Ponikowski P, von Bardeleben R, Koehler F, Ruschitzka F, Damman K, Schwammenthal E, Testani J, Zannad F, Böhm M, Cowie M, Dickstein K, Jaarsma T, Filippatos G, Volterrani M, Thum T, Adamopoulos S, Cohen‐Solal A, Moura B, Rakisheva A, Ristic A, Bayes‐Genis A, Van Linthout S, Tocchetti C, Savarese G, Skouri H, Adamo M, Amir O, Yilmaz M, Simpson M, Tokmakova M, González A, Piepoli M, Seferovic P, Metra M, Coats A, Rosano G. Integration of implantable device therapy in patients with heart failure. A clinical consensus statement from the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). European Journal Of Heart Failure 2024, 26: 483-501. PMID: 38269474, DOI: 10.1002/ejhf.3150.Peer-Reviewed Original ResearchEuropean Heart Rhythm AssociationEuropean Society of CardiologyHeart Failure AssociationHeart failureSociety of CardiologyDevice therapyFailure AssociationOptimization of drug therapyCardiac resynchronization therapyManagement of patientsImplantable device therapyEuropean SocietyImplantable cardioverter-defibrillatorClinical consensus statementClinical consensus documentClinical care pathwayReverse remodelingResynchronization therapyImproved haemodynamicsAdjunctive therapyAdvanced HFHF patientsDrug therapyCardioverter-defibrillatorLong-term mechanical support
2023
Kidney and heart failure events are bidirectionally associated in patients with type 2 diabetes and cardiovascular disease
Sharma A, Inzucchi S, Testani J, Ofstad A, Fitchett D, Mattheus M, Verma S, Zannad F, Wanner C, Kraus B. Kidney and heart failure events are bidirectionally associated in patients with type 2 diabetes and cardiovascular disease. ESC Heart Failure 2023, 11: 737-747. PMID: 38155446, PMCID: PMC10966270, DOI: 10.1002/ehf2.14601.Peer-Reviewed Original ResearchPlacebo-treated participantsKidney eventsType 2 diabetesHeart failureCV eventsBaseline factorsLow-density lipoprotein cholesterol levelsMajor adverse CV eventsEMPA-REG OUTCOMEPrior heart failureAdverse CV eventsHeart failure eventsGlomerular filtration rateLipoprotein cholesterol levelsCoronary artery diseaseCox regression modelHigh uric acidUse of therapiesCardiovascular eventsCV diseaseHF outcomesArtery diseaseCholesterol levelsFiltration rateSubsequent riskAssociation of Tricuspid Regurgitant Jet Velocity with Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction in TOPCAT
Oka T, Tighiouart H, McCallum W, Tuttle M, Testani J, Sarnak M. Association of Tricuspid Regurgitant Jet Velocity with Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction in TOPCAT. Journal Of The American Society Of Nephrology 2023, 34: 144-144. DOI: 10.1681/asn.20233411s1144c.Peer-Reviewed Original ResearchAssociation of Aortic Pulsatility Index with Clinical Outcomes and In-Hospital eGFR Slope Among Patients Admitted for Acute Decompensated Heart Failure Requiring Hemodynamic Monitoring
Banlengchit R, Tighiouart H, Tuttle M, Moises A, Sarnak H, Testani J, Oka T, Kiernan M, Sarnak M, McCallum W. Association of Aortic Pulsatility Index with Clinical Outcomes and In-Hospital eGFR Slope Among Patients Admitted for Acute Decompensated Heart Failure Requiring Hemodynamic Monitoring. Journal Of The American Society Of Nephrology 2023, 34: 761-761. DOI: 10.1681/asn.20233411s1761b.Peer-Reviewed Original ResearchAssociation of Pulmonary Arterial Pulsatility Index (PAPi) with Kidney Outcomes Among Patients Admitted for Acute Decompensated Heart Failure
Tuttle M, Tighiouart H, Testani J, Banlengchit R, Moises A, Sarnak H, Oka T, Kiernan M, Sarnak M, McCallum W. Association of Pulmonary Arterial Pulsatility Index (PAPi) with Kidney Outcomes Among Patients Admitted for Acute Decompensated Heart Failure. Journal Of The American Society Of Nephrology 2023, 34: 144-145. DOI: 10.1681/asn.20233411s1144d.Peer-Reviewed Original ResearchCardiorenal interactions in heart failure: insights from recent therapeutic advances
Damman K, Testani J. Cardiorenal interactions in heart failure: insights from recent therapeutic advances. Cardiovascular Research 2023, cvad096. PMID: 37364186, DOI: 10.1093/cvr/cvad096.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsHeart failureRisk patientsCardiovascular diseaseNew therapiesHigh cardiovascular risk patientsOutcomes of patientsCardiovascular risk patientsChronic kidney diseaseHigh-risk patientsRecent therapeutic advancesSpecific drug classesHigh mortality rateHealth care expendituresCardiorenal continuumCardiorenal interactionsMRA therapyRenal endpointsCardiovascular eventsCardiorenal diseaseKidney diseaseTherapeutic advancesDrug classesTherapeutic approachesMortality ratePatientsSodium restriction in patients with chronic heart failure and reduced ejection fraction: A randomized controlled trial
Ivey-Miranda J, Almeida-Gutierrez E, Herrera-Saucedo R, Posada-Martinez E, Chavez-Mendoza A, Mendoza-Zavala G, Cigarroa-Lopez J, Magaña-Serrano J, Rivera-Leaños R, Treviño-Mejia A, Revilla-Monsalve C, Flores-Umanzor E, Espinola-Zavaleta N, Orea-Tejeda A, Garduño-Espinosa J, Saturno-Chiu G, Rao VS, Testani J, Borrayo-Sanchez G. Sodium restriction in patients with chronic heart failure and reduced ejection fraction: A randomized controlled trial. Cardiology Journal 2023, 30: 411-421. PMID: 34490604, PMCID: PMC10287066, DOI: 10.5603/cj.a2021.0098.Peer-Reviewed Original ResearchConceptsQuality of lifeSodium restrictionAdverse safety eventsNT-proBNPHeart failureSodium intakeEjection fractionSafety eventsN-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideStable HF patientsChronic heart failureNT-proBNP levelsReduced ejection fractionLow sodium intakeBeneficial cardiac effectsAdverse safety signalsSolid clinical evidenceGOV IDENTIFIERUrinary sodiumHF patientsSymptomatic hypotensionCardiac effectsSecondary outcomesBlood pressureAssociation of Urine Galectin-3 With Cardiorenal Outcomes in Patients With Heart Failure
Rao V, Ivey-Miranda J, Cox Z, Moreno-Villagomez J, Testani J. Association of Urine Galectin-3 With Cardiorenal Outcomes in Patients With Heart Failure. Journal Of Cardiac Failure 2023, 30: 340-346. PMID: 37301248, PMCID: PMC10947725, DOI: 10.1016/j.cardfail.2023.05.018.Peer-Reviewed Original ResearchGalectin-3 levelsHeart failureGalectin-3Renal fibrosisCardiac Function Heart FailureAldosterone Antagonist TrialContemporary HF cohortChronic kidney diseaseGlomerular filtration rateLow-risk phenotypeSignificant effect modificationLower eGFR levelsRenal tissue fibrosisAmino-terminal propeptideType III procollagenCardiorenal dysfunctionCardiorenal outcomesTOPCAT studyCause mortalityHF cohortSerum creatinineClinic cohortPrognostic importanceKidney diseasePrognostic indicatorSGLT2 inhibitors and diuretics in heart failure: clicking reset on the renal volume setpoint?
Borlaug B, Testani J. SGLT2 inhibitors and diuretics in heart failure: clicking reset on the renal volume setpoint? European Heart Journal 2023, 44: 2944-2946. PMID: 37220086, DOI: 10.1093/eurheartj/ehad345.Commentaries, Editorials and LettersThe blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure
Biegus J, Zymliński R, Testani J, Fudim M, Cox Z, Guzik M, Iwanek G, Hurkacz M, Raj D, Marciniak D, Ponikowska B, Ponikowski P. The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure. European Journal Of Heart Failure 2023, 25: 1323-1333. PMID: 37042083, DOI: 10.1002/ejhf.2852.Peer-Reviewed Original ResearchConceptsAcute heart failureDiuretic responseHeart failureChronic usersTubular deliveryUrine volumeAcute heart failure patientsGlomerular filtration rateHeart failure patientsHigher urine volumeDiuretic exposureFurosemide deliveryFurosemide usersGood diuresisFurosemide doseFailure patientsNatriuretic responseFurosemide useTubular responseFiltration rateObservational studyUrine excretionNaïve groupHealthy individualsBody weightThe importance of forward flow and venous congestion in diuretic response in acute heart failure: Insights from the ESCAPE trial
Eder M, Griffin M, Moreno-Villagomez J, Bellumkonda L, Maulion C, Asher J, Wilson F, Cox Z, Ivey-Miranda J, Rao V, Butler J, Borlaug B, McCallum W, Ramos-Mastache D, Testani J. The importance of forward flow and venous congestion in diuretic response in acute heart failure: Insights from the ESCAPE trial. International Journal Of Cardiology 2023, 381: 57-61. PMID: 37023862, DOI: 10.1016/j.ijcard.2023.04.002.Peer-Reviewed Original ResearchConceptsRight atrial pressureDiuretic efficiencyRight atrial areaDiuretic responseVenous congestionHeart failureCardio-renal interactionsLoop diuretic doseAcute heart failureRenal perfusion pressureLow cardiac outputMean arterial pressureRight ventricular systolicCongestive heart failureVentricular ejection fractionNet fluid outputForward flowDiuretic doseDiuretic resistanceTTE parametersCardiac indexVentricular systolicArterial pressureAtrial pressureEjection fractionIn-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility
Ivey-Miranda J, Rao V, Cox Z, Moreno-Villagomez J, Mahoney D, Maulion C, Bellumkonda L, Turner J, Collins S, Wilson F, Krumholz H, Testani J. In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility. Circulation Heart Failure 2023, 16: e010206. PMID: 36896716, PMCID: PMC10186250, DOI: 10.1161/circheartfailure.122.010206.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureDiuretic responseDiuretic dosingOral diureticsHeart failureMulticenter cohortHospital observationLower readmission ratesNet fluid balanceDays postdischargeReadmission ratesHospital readmissionUrine outputReadmission riskFluid statusFluid balanceHospital measuresDose selectionCohortProvider decisionsWeight changeReadmissionDiureticsPatientsImprovement in Renal Function During the Treatment of Acute Decompensated Heart Failure: Relationship With Markers of Renal Tubular Injury and Prognostic Importance
Natov P, Ivey-Miranda J, Cox Z, Moreno-Villagomez J, Maulion C, Bellumkonda L, Shlipak M, Estrella M, Borlaug B, Rao V, Testani J. Improvement in Renal Function During the Treatment of Acute Decompensated Heart Failure: Relationship With Markers of Renal Tubular Injury and Prognostic Importance. Circulation Heart Failure 2023, 16: e009776. PMID: 36700431, PMCID: PMC10150783, DOI: 10.1161/circheartfailure.122.009776.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureStable renal functionGlomerular filtration rateRenal functionRenal tubular injuryHeart failureTubular injuryKIM-1Filtration rateRenal tubular injury markersTubular injury markersRenal function groupCumulative urine outputCardiorenal dysfunctionDiuretic dosesInjury markersWorse survivalWorsened survivalUrine outputDecongestive therapyPrognostic importanceAdverse outcomesLower admissionPatients