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
2014
A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure
Testani JM, Damman K, Brisco MA, Chen S, Laur O, Kula AJ, Tang WH, Parikh C. A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure. Journal Of Cardiac Failure 2014, 20: 912-919. PMID: 25152498, PMCID: PMC4292792, DOI: 10.1016/j.cardfail.2014.08.008.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBiomarkersBlood Urea NitrogenCardio-Renal SyndromeCohort StudiesConfidence IntervalsCreatinineFemaleGlomerular Filtration RateHeart FailureHospitals, UniversityHumansMaleMiddle AgedPhenotypePrognosisRenal InsufficiencyRetrospective StudiesSensitivity and SpecificityStatistics, NonparametricSurvival RateConceptsB-type natriuretic peptideElevated B-type natriuretic peptideRenal dysfunctionHeart failureLower B-type natriuretic peptideUse of BNPCombined biomarker approachDecompensated heart failureIntrinsic kidney diseaseBlood urea nitrogenDifferent clinical phenotypesBUN/Diuretic resistanceInotrope useWorse survivalCreatinine ratioRisk stratificationDischarge diagnosisNatriuretic peptideVenous congestionKidney diseaseStratify patientsClinical phenotypingPatientsUrea nitrogen
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 admissionsBiochemical Evidence of Mild Hepatic Dysfunction Identifies Decompensated Heart Failure Patients With Reversible Renal Dysfunction
Brisco MA, McCauley BD, Chen J, Parikh CR, Testani JM. Biochemical Evidence of Mild Hepatic Dysfunction Identifies Decompensated Heart Failure Patients With Reversible Renal Dysfunction. Journal Of Cardiac Failure 2013, 19: 739-745. PMID: 24263117, PMCID: PMC3884639, DOI: 10.1016/j.cardfail.2013.10.005.Peer-Reviewed Original ResearchConceptsReversible renal dysfunctionRenal dysfunctionLiver dysfunctionElevated international normalized ratioDecompensated heart failure patientsBaseline renal dysfunctionCharacteristic laboratory abnormalitiesDecompensated HF patientsLiver dysfunction resultsSigns of HFGlomerular filtration rateHeart failure patientsMild liver dysfunctionInternational normalized ratioIntrinsic kidney diseaseBiochemical evidenceHF patientsFailure patientsLaboratory abnormalitiesRenal functionPathophysiologic factorsDischarge diagnosisKidney diseaseMultifactorial pathophysiologyNormalized ratioTiming 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
Clinical Characteristics and Outcomes of Patients With Improvement in Renal Function During the Treatment of Decompensated Heart Failure
Testani JM, McCauley BD, Chen J, Coca SG, Cappola TP, Kimmel SE. Clinical Characteristics and Outcomes of Patients With Improvement in Renal Function During the Treatment of Decompensated Heart Failure. Journal Of Cardiac Failure 2011, 17: 993-1000. PMID: 22123361, PMCID: PMC3248245, DOI: 10.1016/j.cardfail.2011.08.009.Peer-Reviewed Original ResearchConceptsDecompensated heart failureRenal functionHeart failureRenal dysfunctionAcute decompensated heart failureVolume of diuresisOutcomes of patientsCongestive heart failureGlomerular filtration rateCardiorenal interactionsIRF patientsClinical characteristicsHemodynamic derangementsConsecutive patientsCardiac dysfunctionDischarge diagnosisPoor prognosisFiltration rateMortality riskEligibility criteriaPatientsGreater incidenceDysfunctionUniversity of PennsylvaniaIRFImpact 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
Worsening Renal Function Defined as an Absolute Increase in Serum Creatinine Is a Biased Metric for the Study of Cardio-Renal Interactions
Testani JM, McCauley BD, Chen J, Shumski M, Shannon RP. Worsening Renal Function Defined as an Absolute Increase in Serum Creatinine Is a Biased Metric for the Study of Cardio-Renal Interactions. Cardiology 2010, 116: 206-212. PMID: 20689277, PMCID: PMC2992648, DOI: 10.1159/000316038.Peer-Reviewed Original ResearchConceptsBaseline renal functionCardio-renal interactionsRenal functionSerum creatinineHeart failureStrong adverse prognostic factorAbsolute increaseBaseline renal insufficiencyDecompensated heart failureAdverse prognostic factorPrediction of mortalityRenal insufficiencyPrognostic factorsDischarge diagnosisConsecutive admissionsUnadjusted associationsCreatinineAbsolute changeAdmissionDlFuture studiesGFRFailureInsufficiencyMortalityEffect of Right Ventricular Function and Venous Congestion on Cardiorenal Interactions During the Treatment of Decompensated Heart Failure
Testani JM, Khera AV, St. John Sutton MG, Keane MG, Wiegers SE, Shannon RP, Kirkpatrick JN. Effect of Right Ventricular Function and Venous Congestion on Cardiorenal Interactions During the Treatment of Decompensated Heart Failure. The American Journal Of Cardiology 2010, 105: 511-516. PMID: 20152246, PMCID: PMC2995805, DOI: 10.1016/j.amjcard.2009.10.020.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersCardiac Output, LowCohort StudiesCreatinineDiureticsFemaleGlomerular Filtration RateHeart FailureHospitals, UniversityHumansHyperemiaIncidenceKidney DiseasesKidney Function TestsLength of StayMaleMiddle AgedNatriuretic Peptide, BrainPredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexUltrasonographyVentricular Dysfunction, RightConceptsSignificant RV dysfunctionDecompensated heart failureRV dysfunctionRenal functionGlomerular filtration rateVenous congestionCardiac outputHeart failureFiltration rateAcute decompensated heart failureMultiple echocardiographic methodsRight ventricular dysfunctionWorsening Renal FunctionRight ventricular functionCardiorenal interactionsRenal outcomesVentricular dysfunctionRV dilationRV functionVentricular functionDischarge diagnosisConsecutive admissionsEchocardiographic methodsLower incidenceHigh incidence