2024
Sodium Zirconium Cyclosilicate in HFrEF and Hyperkalemia REALIZE-K Design and Baseline Characteristics
Kosiborod M, Cherney D, Connelly K, Desai A, Guimarães P, Kuthi L, Lala A, Madrini V, Merkely B, Villota J, Squire I, Testani J, Vaclavik J, Verma S, Wranicz J, Dahl M, Eudicone J, Friberg L, Petrie M. Sodium Zirconium Cyclosilicate in HFrEF and Hyperkalemia REALIZE-K Design and Baseline Characteristics. JACC Heart Failure 2024, 12: 1707-1716. PMID: 38878009, DOI: 10.1016/j.jchf.2024.05.003.Peer-Reviewed Original ResearchMineralocorticoid receptor antagonistsSodium zirconium cyclosilicateZirconium cyclosilicateBaseline characteristicsOpen-label run-inN-terminal pro B-type natriuretic peptideMineralocorticoid receptor antagonist useRun-inPro B-type natriuretic peptideB-type natriuretic peptidePlacebo-controlled trialRisk of hyperkalemiaReduced ejection fractionPrimary composite endpointDouble-blindEjection fractionReceptor antagonistLowered potassiumOptimal therapyNatriuretic peptideIncident hyperkalemiaProportion of participantsTherapy useHFrEFComposite endpoint
2021
Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure
Fudim M, Spates T, Sun JL, Kittipibul V, Testani JM, Starling RC, Tang WHW, Hernandez AF, Felker GM, O'Connor CM, Mentz RJ. Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure. American Heart Journal 2021, 239: 110-119. PMID: 34052212, DOI: 10.1016/j.ahj.2021.05.011.Peer-Reviewed Original ResearchMeSH KeywordsCreatinineDiureticsDrug MonitoringFemaleFurosemideHeart FailureHospitalizationHumansInfusions, IntravenousInjections, IntravenousMaleMiddle AgedMortalityNatriuretic Peptide, BrainOutcome and Process Assessment, Health CarePatient ReadmissionPeptide FragmentsTime-to-TreatmentUnited StatesConceptsIntermittent bolus administrationAcute heart failureDecompensated heart failureHeart failurePost-discharge outcomesDiuretic strategyDay mortalityBolus administrationDays/dischargeHigher baseline creatinineIntermittent bolus groupTotal urine outputBaseline creatinineDiuretic regimenHigh NTproBNPCause mortalityHF readmissionHF rehospitalizationHospital outcomesBaseline characteristicsCardiovascular mortalityIn-HospitalRenal functionBolus groupContinuous therapy
2018
Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis
Brisco‐Bacik M, Maaten J, Houser SR, Vedage NA, Rao V, Ahmad T, Wilson FP, Testani JM. Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis. Journal Of The American Heart Association 2018, 7: e009149. PMID: 30371181, PMCID: PMC6222930, DOI: 10.1161/jaha.118.009149.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedCause of DeathDose-Response Relationship, DrugFemaleFollow-Up StudiesGuideline AdherenceHeart FailureHumansInjections, IntravenousMaleMetolazonePropensity ScoreRetrospective StudiesSodium Chloride Symporter InhibitorsSodium Potassium Chloride Symporter InhibitorsStroke VolumeSurvival RateTreatment OutcomeUnited StatesConceptsHigh-dose loop diureticsAcute decompensated heart failureDecompensated heart failureLoop diureticsRenal functionPropensity adjustmentHeart failureCommon electronic medical recordIntravenous loop diureticsLoop diuretic dosePropensity-adjusted analysisThiazide-type diureticsControl trial dataElectronic medical recordsDiuretic doseDiuretic strategyCause mortalityAdverse eventsBaseline characteristicsSecondary outcomesThiazide diureticsResults PatientsDischarge diagnosisMedical recordsDiuretics
2016
The risk of death associated with proteinuria in heart failure is restricted to patients with an elevated blood urea nitrogen to creatinine ratio
Brisco MA, Zile MR, Maaten J, Hanberg JS, Wilson FP, Parikh C, Testani JM. The risk of death associated with proteinuria in heart failure is restricted to patients with an elevated blood urea nitrogen to creatinine ratio. International Journal Of Cardiology 2016, 215: 521-526. PMID: 27153048, PMCID: PMC4986924, DOI: 10.1016/j.ijcard.2016.04.100.Peer-Reviewed Original ResearchConceptsElevated blood urea nitrogenBUN/CrRenal dysfunctionBlood urea nitrogenCreatinine ratioUrea nitrogenLeft Ventricular Dysfunction (SOLVD) trialVentricular Dysfunction trialsGlomerular filtration rateRisk of deathBaseline characteristicsWorsened survivalAdverse eventsHeart failureTop tertileFiltration rateBottom tertileProteinuriaSurvival disadvantagePatientsMortalityTertileDysfunctionSurvivalSurvival models
2015
Evidence of Mild Liver Dysfunction Identifies Stable Heart Failure Outpatients with Reversible Renal Dysfunction
Brisco MA, Cheng SJ, Laur O, Kula AJ, Testani JM. Evidence of Mild Liver Dysfunction Identifies Stable Heart Failure Outpatients with Reversible Renal Dysfunction. Cardiorenal Medicine 2015, 5: 229-236. PMID: 26195975, PMCID: PMC4478303, DOI: 10.1159/000430505.Peer-Reviewed Original ResearchReversible renal dysfunctionStable HF outpatientsMild liver dysfunctionAlanine aminotransferaseAspartate aminotransferaseHF outpatientsRenal dysfunctionElevated bilirubinLiver dysfunctionHeart failurePoor perfusionBeta-Blocker EvaluationDecompensated heart failureHeart failure outpatientsGlomerular filtration rateSigns of congestionBaseline characteristicsRenal functionPathophysiologic factorsLiver parametersFiltration ratePatientsDysfunctionOutpatientsBilirubinSubstantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment
Testani JM, Brisco MA, Kociol RD, Jacoby D, Bellumkonda L, Parikh CR, Coca SG, Tang WH. Substantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment. The American Journal Of Medicine 2015, 128: 776-783.e4. PMID: 25595470, PMCID: PMC4475432, DOI: 10.1016/j.amjmed.2014.12.020.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAge FactorsAgedAged, 80 and overBody FluidsCohort StudiesDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Administration ScheduleFemaleFollow-Up StudiesHeart FailureHumansInfusions, IntravenousMaleMiddle AgedRandomized Controlled Trials as TopicRisk AssessmentSeverity of Illness IndexSex FactorsStatistics, NonparametricSurvival RateTreatment OutcomeWeight LossConceptsAcute decompensated heart failureDecompensated heart failureDiuretic Optimization Strategies EvaluationHeart failureWeight lossAcute Decompensated Heart Failure (CARRESS-HF) trialPatient careDecompensated Heart Failure (ASCEND-HF) trialPulmonary Artery Catheterization EffectivenessAcute decompensated heartHeart Failure TrialCongestive heart failureHeart failure researchBaseline characteristicsDiuretic responseFailure TrialLimits of agreementFailure treatmentFluid balanceDecompensated heartNet fluidGreater fluidPatientsCareTreatment
2013
Loop Diuretic Efficiency
Testani JM, Brisco MA, Turner JM, Spatz ES, Bellumkonda L, Parikh CR, Tang WH. Loop Diuretic Efficiency. Circulation Heart Failure 2013, 7: 261-270. PMID: 24379278, PMCID: PMC4386906, DOI: 10.1161/circheartfailure.113.000895.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseCause of DeathDiuresisDose-Response Relationship, DrugFemaleFollow-Up StudiesGlomerular Filtration RateHeart FailureHospital MortalityHumansInjections, IntravenousMaleMiddle AgedPatient DischargePennsylvaniaPrognosisProspective StudiesSodium Potassium Chloride Symporter InhibitorsSurvival RateTreatment OutcomeConceptsLower diuretic efficiencyDiuretic efficiencyNet fluid outputDiuretic doseHeart failureFluid outputBaseline characteristicsPoor long-term outcomesDecompensated heart failureDistinct prognostic informationDose of diureticsPrimary discharge diagnosisCongestive heart failureTraditional prognostic factorsLong-term outcomesCatheterization variablesFurosemide equivalentsDiuretic therapyRenal functionWorsened survivalPrognostic factorsUrine outputDecongestive therapyDischarge diagnosisConsecutive admissionsTiming of Hemoconcentration During Treatment of Acute Decompensated Heart Failure and Subsequent Survival Importance of Sustained Decongestion
Testani JM, Brisco MA, Chen J, McCauley BD, Parikh CR, Tang WH. Timing of Hemoconcentration During Treatment of Acute Decompensated Heart Failure and Subsequent Survival Importance of Sustained Decongestion. Journal Of The American College Of Cardiology 2013, 62: 516-524. PMID: 23747773, PMCID: PMC3892152, DOI: 10.1016/j.jacc.2013.05.027.Peer-Reviewed Original ResearchConceptsDecompensated heart failureHeart failureEarly hemoconcentrationIntravascular volumeSurvival advantageAcute decompensated heart failureLoop diuretic dosesSignificant mortality benefitPrimary discharge diagnosisSimilar baseline characteristicsSignificant survival advantageGreater weight lossDiuretic dosesOral diureticsBaseline characteristicsMortality benefitRenal functionImproved survivalLoop diureticsSingle centerDischarge diagnosisHealthy patientsConsecutive admissionsDiuretic responsivenessRapid diuresisBlood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure
Brisco MA, Coca SG, Chen J, Owens AT, McCauley BD, Kimmel SE, Testani JM. Blood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure. Circulation Heart Failure 2013, 6: 233-239. PMID: 23325460, PMCID: PMC4067251, DOI: 10.1161/circheartfailure.112.968230.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersBlood Urea NitrogenCardio-Renal SyndromeChi-Square DistributionCreatinineFemaleGlomerular Filtration RateHeart FailureHumansKaplan-Meier EstimateKidneyLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient AdmissionPrognosisProportional Hazards ModelsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsUp-RegulationConceptsReversible renal dysfunctionBUN/CrBlood urea nitrogen/creatinine ratioUrea nitrogen/creatinine ratioHeart failureRenal functionRenal dysfunctionCreatinine ratioElevated BUN/CrPatients meeting eligibility criteriaDecompensated heart failure patientsDecompensated heart failureHigh-risk patientsHeart failure patientsGlomerular filtration rateRisk of deathMeeting eligibility criteriaConsecutive hospitalizationsBaseline characteristicsFailure patientsDischarge diagnosisFiltration rateEligibility criteriaPatientsReversible form
2011
Interaction Between Loop Diuretic-Associated Mortality and Blood Urea Nitrogen Concentration in Chronic Heart Failure
Testani JM, Cappola TP, Brensinger CM, Shannon RP, Kimmel SE. Interaction Between Loop Diuretic-Associated Mortality and Blood Urea Nitrogen Concentration in Chronic Heart Failure. Journal Of The American College Of Cardiology 2011, 58: 375-382. PMID: 21757114, PMCID: PMC3980479, DOI: 10.1016/j.jacc.2011.01.052.Peer-Reviewed Original ResearchConceptsHigh-dose loop diureticsBlood urea nitrogenLoop diureticsBUN levelsNeurohormonal activationBaseline characteristicsHeart failureNormal BUN levelChronic heart failureRisk of deathBlood urea nitrogen concentrationElevated BUN levelsCongestive symptomsOverall cohortWorsened survivalImproved survivalPrimary outcomeAdverse outcomesUrea nitrogen concentrationDiureticsUrea nitrogenBUN concentrationPatientsMortalitySurvivalImpact of worsening renal function during the treatment of decompensated heart failure on changes in renal function during subsequent hospitalization
Testani JM, Cappola TP, McCauley BD, Chen J, Shen J, Shannon RP, Kimmel SE. Impact of worsening renal function during the treatment of decompensated heart failure on changes in renal function during subsequent hospitalization. American Heart Journal 2011, 161: 944-949. PMID: 21570527, PMCID: PMC3095914, DOI: 10.1016/j.ahj.2011.02.005.Peer-Reviewed Original ResearchConceptsDecompensated heart failureSubsequent hospitalizationRenal functionHeart failureCardiorenal pathophysiologyIndex hospitalizationAcute decompensated heart failureBaseline patient characteristicsCongestive heart failurePatient-related factorsTreatment-related parametersBaseline characteristicsBaseline factorsPatient characteristicsDischarge diagnosisHospital treatmentConsecutive admissionsInclusion criteriaHospitalizationPrior historySubsequent episodesPrimary hypothesisMinimal associationPatientsSignificant correlation
2010
Potential Effects of Aggressive Decongestion During the Treatment of Decompensated Heart Failure on Renal Function and Survival
Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential Effects of Aggressive Decongestion During the Treatment of Decompensated Heart Failure on Renal Function and Survival. Circulation 2010, 122: 265-272. PMID: 20606118, PMCID: PMC3025294, DOI: 10.1161/circulationaha.109.933275.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBlood ProteinsBlood VolumeExtracellular FluidFemaleGlomerular Filtration RateHeart FailureHematocritHumansKidneyMaleMiddle AgedPulmonary Wedge PressureSerum AlbuminSodium Chloride Symporter InhibitorsSodium Potassium Chloride Symporter InhibitorsTreatment OutcomeVentricular PressureConceptsDecompensated heart failureRenal functionAggressive decongestionHeart failurePulmonary Artery Catheterization Effectiveness trialPulmonary capillary wedge pressureAggressive fluid removalCapillary wedge pressureIntravascular volume depletionRight atrial pressureCongestive heart failureEvidence of hemoconcentrationAggressive diuresisIntravascular substancesWedge pressureAtrial pressureBaseline characteristicsLoop diureticsTop tertileVolume depletionEffectiveness trialExtravascular fluidFluid removalHemoconcentrationHigh doses