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, 29: 1161-1173. PMID: 39128947, PMCID: PMC11455821, 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 gapsTrialsTherapyFailure
2022
Classic and Novel Mechanisms of Diuretic Resistance in Cardiorenal Syndrome
Cox ZL, Rao VS, Testani JM. Classic and Novel Mechanisms of Diuretic Resistance in Cardiorenal Syndrome. Kidney360 2022, 3: 954-967. PMID: 36128483, PMCID: PMC9438407, DOI: 10.34067/kid.0006372021.Commentaries, Editorials and LettersConceptsCardiorenal syndromeDiuretic resistanceSodium avidityAcute decompensated heart failureDecompensated heart failureRenal sodium avidityHeart failure phenotypeResistance mechanismsDiuretic therapyHeart failureFailure populationNovel mechanismMultiple etiologiesGlomerular filtrationTherapeutic strategiesFailure phenotypeSyndromeTranslate findingsAviditySpecific transportersTherapyEtiologyPopulationRecent literature
2021
Multinephron Segment Diuretic Therapy to Overcome Diuretic Resistance in Acute Heart Failure: A Single-Center Experience
Cox ZL, Sarrell BA, Cella MK, Tucker B, Arroyo JP, Umanath K, Tidwell W, Guide A, Testani JM, Lewis JB, Dwyer JP. Multinephron Segment Diuretic Therapy to Overcome Diuretic Resistance in Acute Heart Failure: A Single-Center Experience. Journal Of Cardiac Failure 2021, 28: 21-31. PMID: 34403831, DOI: 10.1016/j.cardfail.2021.07.016.Peer-Reviewed Original ResearchConceptsAcute heart failureDiuretic resistanceDiuretic therapyHeart failureUrine outputSerum chemistryRenal replacement therapySingle medical centerSingle-center experienceAHF cohortDiuretic classesHospital mortalityTotal cohortKidney functionSerum sodiumCarbonic anhydrase inhibitorsProspective studyReplacement therapyCase-level evidenceRetrospective analysisMedical CenterDay 7Own controlTherapyPatientsNatriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure
Rao VS, Ivey-Miranda JB, Cox ZL, Riello R, Griffin M, Fleming J, Soucier R, Sangkachand P, O'Brien M, LoRusso F, D'Ambrosi J, Churchwell K, Mahoney D, Bellumkonda L, Asher JL, Maulion C, Turner JM, Wilson FP, Collins SP, Testani JM. Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure. Journal Of The American College Of Cardiology 2021, 77: 695-708. PMID: 33573739, PMCID: PMC8114781, DOI: 10.1016/j.jacc.2020.12.022.Peer-Reviewed Original ResearchConceptsLoop diuretic administrationDiuretic therapyNatriuretic responseDiuretic administrationSodium outputAcute decompensated heart failureDecompensated heart failureHeart failure admissionsDaily urine outputSpot urine samplesNet fluid outputNet fluid lossPathway cohortHeart failureLoop diureticsUrine outputDiuretic responseResidual congestionFluid outputTherapyCohortWeight lossAdditional studiesUrine samplesExcellent discrimination
2020
Diuretic Therapy for Patients With Heart Failure JACC State-of-the-Art Review
Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients With Heart Failure JACC State-of-the-Art Review. Journal Of The American College Of Cardiology 2020, 75: 1178-1195. PMID: 32164892, DOI: 10.1016/j.jacc.2019.12.059.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsHeart failureDiuretic therapyElevated intracardiac filling pressuresRobust clinical trial evidenceFailure JACC StateIntracardiac filling pressuresUse of diureticsClinical trial evidenceCornerstone of treatmentConstellation of signsMajor clinical challengeExtracellular fluid volumeDiuretic pharmacokineticsDiuretic regimenDiuretic resistanceLoop diureticsPoor prognosisTrial evidenceOutpatient settingJACC StateFilling pressureClinical challengeDiureticsRenal physiologyTherapy
2019
Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure The 3T Trial
Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure The 3T Trial. JACC Heart Failure 2019, 8: 157-168. PMID: 31838029, PMCID: PMC7058489, DOI: 10.1016/j.jchf.2019.09.012.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedChlorothiazideDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Therapy, CombinationFemaleFollow-Up StudiesFurosemideHeart FailureHumansInfusions, IntravenousMaleMetolazoneMiddle AgedProspective StudiesRetrospective StudiesTolvaptanTreatment OutcomeConceptsAcute heart failureLoop diuretic resistanceDiuretic resistanceHigh-dose loop diuretic therapyLoop diuretic therapyDouble-blinded trialInfusion of furosemideCombination diureticsDiuretic strategyDiuretic therapyOral metolazoneTolvaptan therapyDiuretic efficacyHeart failurePrimary outcomePatientsLimited evidenceWeight lossTherapyChlorothiazideMetolazoneTolvaptanDiureticsInfusionCohortControlled decongestion by Reprieve therapy in acute heart failure: results of the TARGET‐1 and TARGET‐2 studies
Biegus J, Zymlinski R, Siwolowski P, Testani J, Szachniewicz J, Tycińska A, Banasiak W, Halpert A, Levin H, Ponikowski P. Controlled decongestion by Reprieve therapy in acute heart failure: results of the TARGET‐1 and TARGET‐2 studies. European Journal Of Heart Failure 2019, 21: 1079-1087. PMID: 31127666, DOI: 10.1002/ejhf.1533.Peer-Reviewed Original ResearchConceptsAcute heart failureEnd of therapyHeart failureDiuretic-based regimenStandard diuretic therapyPatient global assessmentPrimary efficacy endpointCentral venous pressureSystolic blood pressureDiuretic therapyEffective decongestionMean diuresisEfficacy endpointRenal injuryBlood pressureVenous pressureMean creatinineOwn controlPatientsTherapyGlobal assessmentFluid lossSodium lossTherapy supportDecongestionDiuretic Resistance in Heart Failure
Gupta R, Testani J, Collins S. Diuretic Resistance in Heart Failure. Current Heart Failure Reports 2019, 16: 57-66. PMID: 30762178, PMCID: PMC6431570, DOI: 10.1007/s11897-019-0424-1.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsAcute heart failureLoop diuretic doseHeart failureDiuretic doseLoop diureticsChronic heart failureUrine sodium concentrationDiuretic resistanceNatriuretic responseDiuretic efficiencyInpatient stayPrognostic valueFuture trialsDiuretic responsivenessAdditional biomarkersTailored therapyDiureticsSodium concentrationTherapyCurrent literatureAdministrationDoseOverview of mechanismsRecent studiesDR
2014
Novel Renal Biomarkers to Assess Cardiorenal Syndrome
Brisco MA, Testani JM. Novel Renal Biomarkers to Assess Cardiorenal Syndrome. Current Heart Failure Reports 2014, 11: 485-499. PMID: 25239434, PMCID: PMC4224613, DOI: 10.1007/s11897-014-0226-4.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsRenal dysfunctionCardiorenal syndromeHeart failureRenal biomarkersNormal glomerular filtration rateIrreversible nephron lossSignificant renal impairmentHypertensive kidney diseaseGlomerular filtration rateNovel renal biomarkersCardiorenal interactionsRenal impairmentNephron lossDecongestive therapyAdverse outcomesKidney diseaseFiltration rateHigh prevalenceRenal performanceSyndromeBiomarkersFailurePrognosisDysfunctionTherapyAcute Kidney Injury in the Era of Ventricular Assist Devices
Brisco M, Testani J. Acute Kidney Injury in the Era of Ventricular Assist Devices. 2014, 111-124. DOI: 10.1007/978-1-4939-1273-5_9.ChaptersAcute kidney injuryVentricular assist deviceRenal functionKidney injuryRenal dysfunctionAssist deviceDurable mechanical circulatory supportAdvanced heart failureMajority of patientsMechanical circulatory supportRenal outcomesCardiac transplantationVAD implantationVAD placementHeart failureCirculatory supportPoor prognosisDestination therapyClinical significanceSignificant burdenPatientsGreater riskDysfunctionTherapyInjury
2011
Prognostic Importance of Early Worsening Renal Function After Initiation of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Cardiac Dysfunction
Testani JM, Kimmel SE, Dries DL, Coca SG. Prognostic Importance of Early Worsening Renal Function After Initiation of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Cardiac Dysfunction. Circulation Heart Failure 2011, 4: 685-691. PMID: 21903907, PMCID: PMC3248247, DOI: 10.1161/circheartfailure.111.963256.Peer-Reviewed Original ResearchConceptsGlomerular filtration rateRenal functionPrognostic significanceAngiotensin-Converting Enzyme Inhibitor TherapyACE-I therapySetting of angiotensinWorsening Renal FunctionEnzyme inhibitor therapyPrimary end pointAdverse prognostic significanceEnalapril groupEnalapril therapyPlacebo groupStudy drugVentricular dysfunctionHeart failureInhibitor therapyCardiac dysfunctionPrognostic importanceFiltration rateSurvival advantageMortality rateOverall populationEnd pointTherapy