2024
Increased 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, 30: 1522-1526. 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 marker
2023
In-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
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
Measures of Loop Diuretic Efficiency and Prognosis in Chronic Kidney Disease
Verbrugge FH, Martens P, Testani JM, Tang WHW, Kuypers D, Bammens B. Measures of Loop Diuretic Efficiency and Prognosis in Chronic Kidney Disease. Cardiorenal Medicine 2020, 10: 402-414. PMID: 33120398, DOI: 10.1159/000509741.Peer-Reviewed Original ResearchConceptsDiuretic efficiencyCause mortalityMedian timeKidney diseaseChronic kidney disease severityLoop diuretic doseLoop diuretic therapyAcute kidney injuryRetrospective cohort studyChronic kidney diseaseRenal replacement therapyOnset of dialysisKidney disease severityCKD patientsDiuretic doseDiuretic therapyFurosemide usersKidney injuryKidney transplantationCohort studyCreatinine clearanceDialysis initiationPrognostic impactLoop diureticsUrine outputSodium glucose cotransporter 2 inhibitors as diuretic adjuvants in acute decompensated heart failure: a case series
Griffin M, Riello R, Rao VS, Ivey-Miranda J, Fleming J, Maulion C, McCallum W, Sarnak M, Collins S, Inzucchi SE, Testani JM. Sodium glucose cotransporter 2 inhibitors as diuretic adjuvants in acute decompensated heart failure: a case series. ESC Heart Failure 2020, 7: 1966-1971. PMID: 32476296, PMCID: PMC7373933, DOI: 10.1002/ehf2.12759.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureSodium-glucose cotransporter 2 inhibitorsGlucose cotransporter 2 inhibitorsDecompensated heart failureCotransporter 2 inhibitorsType 2 diabetesSGLT-2iBlood pressureHeart failureUrine outputYale-New Haven HospitalWeight lossIncidence of hypokalaemiaSGLT-2i initiationSGLT-2i therapyGlucose-lowering medicationsHeart failure outcomesCohort of patientsAverage weight lossDiuretic dosingDiuretic resistanceAdjunctive therapyWorsened survivalDiuretic efficiencyDiuretic monotherapyReal World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience
Griffin M, Soufer A, Goljo E, Colna M, Rao VS, Jeon S, Raghavendra P, D'Ambrosi J, Riello R, Coca SG, Mahoney D, Jacoby D, Ahmad T, Chen M, Tang WHW, Turner J, Mullens W, Wilson FP, Testani JM. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience. JACC Heart Failure 2020, 8: 199-208. PMID: 32035891, PMCID: PMC7814403, DOI: 10.1016/j.jchf.2019.10.012.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureHypertonic saline administrationHypertonic saline therapyHypertonic salineSaline administrationSaline therapyDiuretic efficiencyUrine outputSerum sodiumWeight lossAcute decompensated heartDecompensated heart failureCohort of patientsTotal urine outputReal-world safetyU.S. academic medical centersAcademic medical centerLarge U.S. academic medical centerDiuretic doseCenter experienceHeart failureMetabolic derangementsPrimary analytic approachRespiratory statusClinical variables
2019
Natriuretic Response Is Highly Variable and Associated With 6-Month Survival Insights From the ROSE-AHF Trial
Hodson DZ, Griffin M, Mahoney D, Raghavendra P, Ahmad T, Turner J, Wilson FP, Tang WHW, Rao VS, Collins SP, Mullens W, Testani JM. Natriuretic Response Is Highly Variable and Associated With 6-Month Survival Insights From the ROSE-AHF Trial. JACC Heart Failure 2019, 7: 383-391. PMID: 31047017, PMCID: PMC6501816, DOI: 10.1016/j.jchf.2019.01.007.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureROSE-AHF trialsSodium excretionNet fluid balanceWorse prognosisFluid balanceHigh-dose loop diuretic therapyNegative net fluid balanceGreater sodium excretionLoop diuretic agentsLoop diuretic therapyDecompensated heart failureDietary sodium intakeDiuretic therapyUrinary sodiumNatriuretic responseHeart failureSodium intakeUrine outputSodium retentionVolume overloadFluid retentionSodium balanceDiuretic agentsPrognostic ability
2018
Early urine electrolyte patterns in patients with acute heart failure
Collins SP, Jenkins CA, Baughman A, Miller KF, Storrow AB, Han JH, Brown NJ, Liu D, Luther JM, McNaughton CD, Self WH, Peng D, Testani JM, Lindenfeld J. Early urine electrolyte patterns in patients with acute heart failure. ESC Heart Failure 2018, 6: 80-88. PMID: 30295437, PMCID: PMC6351901, DOI: 10.1002/ehf2.12368.Peer-Reviewed Original ResearchConceptsAcute heart failureDiuretic administrationDiuretic resistanceHeart failureLoop diureticsLow urinary sodiumEscalation of therapyUrine sodium excretionSubset of patientsSystolic blood pressureEmergency department patientsUrine sodium concentrationAHF diagnosisAHF patientsIntravenous diureticsUrinary sodiumED staySodium excretionUrinary electrolytesUrine sodiumNatriuretic responseStandard therapyBlood pressureDepartment patientsUrine output
2016
Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone
Cardinale M, Altshuler J, Testani JM. Efficacy of Intravenous Chlorothiazide for Refractory Acute Decompensated Heart Failure Unresponsive to Adjunct Metolazone. Pharmacotherapy The Journal Of Human Pharmacology And Drug Therapy 2016, 36: 843-851. PMID: 27321568, DOI: 10.1002/phar.1787.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureIntravenous chlorothiazideUrine outputIndex doseOral metolazoneLoop diureticsHigh-dose loop diureticsAdministration of chlorothiazideDecompensated heart failurePrimary end pointRetrospective cohort studyTertiary care hospitalFurosemide equivalentsHospital mortalityImproved diuresisDiuretic dosesLast doseMedian doseCohort studyCare hospitalHeart failureMultiple dosesInstitutional protocolInadequate responseOwn control
2015
Diuretic response in acute heart failure—an analysis from ASCEND-HF
Maaten J, Dunning AM, Valente MA, Damman K, Ezekowitz JA, Califf RM, Starling RC, van der Meer P, O'Connor CM, Schulte PJ, Testani JM, Hernandez AF, Tang WH, Voors AA. Diuretic response in acute heart failure—an analysis from ASCEND-HF. American Heart Journal 2015, 170: 313-321.e4. PMID: 26299229, DOI: 10.1016/j.ahj.2015.05.003.Peer-Reviewed Original ResearchConceptsAcute heart failureLow urine outputLower blood pressureDiuretic responseHospital admissionUrine outputBlood pressureHeart failurePoor baseline renal functionGood diuretic responseHeart failure rehospitalizationPoor diuretic responseBaseline renal functionASCEND-HF trialRisk of deathLong-term useDiuretic unresponsivenessNesiritide treatmentCause mortalityRenal impairmentPoor respondersRenal functionClinical predictorsLoop diureticsASCEND-HF
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 admissions