2023
The 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 fraction
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 outputRacial Differences in Diuretic Efficiency, Plasma Renin, and Rehospitalization in Subjects With Acute Heart Failure
Morris AA, Nayak A, Ko YA, D’Souza M, Felker GM, Redfield MM, Tang WHW, Testani JM, Butler J. Racial Differences in Diuretic Efficiency, Plasma Renin, and Rehospitalization in Subjects With Acute Heart Failure. Circulation Heart Failure 2020, 13: e006827. PMID: 32635768, PMCID: PMC7474850, DOI: 10.1161/circheartfailure.119.006827.Peer-Reviewed Original ResearchConceptsPlasma renin activityAcute heart failureLevels of PRADiuretic efficiencyHeart failureBlack patientsNonblack patientsAcute heart failure clinical trialsRacial differencesBaseline plasma renin activityHeart failure clinical trialsHigher diuretic efficiencyMeasures of decongestionRisk of rehospitalizationNonischemic heart failureNet fluid balanceSubset of subjectsGreater fluid lossRace/ethnic groupsCARRESS-HFDOSE-AHFFurosemide equivalentsROSE-AHFAldosterone systemNT-proBNPSodium 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
Serum and Urine Albumin and Response to Loop Diuretics in Heart Failure
Charokopos A, Griffin M, Rao VS, Inker L, Sury K, Asher J, Turner J, Mahoney D, Cox ZL, Wilson FP, Testani JM. Serum and Urine Albumin and Response to Loop Diuretics in Heart Failure. Clinical Journal Of The American Society Of Nephrology 2019, 14: cjn.11600918. PMID: 31010938, PMCID: PMC6500945, DOI: 10.2215/cjn.11600918.Peer-Reviewed Original ResearchConceptsDiuretic efficiencyHeart failureAlbumin levelsDiuretic excretionDiuretic doseInpatient cohortUrine albuminOutpatient cohortLoop diureticsIL-6Higher urine albuminLoop diuretic doseUrinary albumin levelsLow serum albuminPlasma IL-6Heart failure cohortHuman heart failureDiuretic resistanceSuccessful decongestionDiuretic treatmentSystemic inflammationKidney functionSite of actionSerum albuminSodium outputDiuretic 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
2016
Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF)
Grodin JL, Sun JL, Anstrom KJ, Chen HH, Starling RC, Testani JM, Tang WH. Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). The American Journal Of Cardiology 2016, 119: 78-83. PMID: 27816115, PMCID: PMC5161696, DOI: 10.1016/j.amjcard.2016.09.014.Peer-Reviewed Original ResearchConceptsAcute heart failureSerum Cl levelsHeart failureClinical outcomesDiuretic responseAcute heart failure trialsRenal Optimization Strategies EvaluationShort-term clinical responseCumulative sodium excretionLoop diuretic doseHeart Failure TrialLong-term mortalitySerum chloride levelsCystatin C changesDiuretic dosePostdischarge outcomesSodium excretionCl levelsClinical responseRenal functionDiuretic efficiencyFailure TrialAdditional adjustmentCystatin CTherapeutic implicationsDifferent diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance
Palazzuoli A, Testani JM, Ruocco G, Pellegrini M, Ronco C, Nuti R. Different diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance. International Journal Of Cardiology 2016, 224: 213-219. PMID: 27657476, DOI: 10.1016/j.ijcard.2016.09.005.Peer-Reviewed Original ResearchConceptsLower diuretic efficiencyChronic kidney diseaseDiuretic efficiencyAdverse eventsDose administrationAcute decompensated heart failureDecompensated heart failureAdverse event ratesDiuretic doseWRF occurrenceRenal dysfunctionClinical characteristicsRenal functionHeart failureHD patientsMultivariable analysisClinical statusPrognostic significanceAdverse outcomesContinuous administrationKidney diseaseDE patientsLD patientsBest modalityPatients
2015
Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure
Kula AJ, Hanberg JS, Wilson FP, Brisco MA, Bellumkonda L, Jacoby D, Coca SG, Parikh CR, Tang WHW, Testani JM. Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure. Circulation Heart Failure 2015, 9: e002333. PMID: 26699390, PMCID: PMC4741376, DOI: 10.1161/circheartfailure.115.002333.Peer-Reviewed Original ResearchConceptsBlood pressure reductionDecompensated heart failureNeurohormonal antagonistsRenal functionSBP reductionBlood pressureDiuretic efficiencyHeart failureAcute decompensated heart failure hospitalizationAcute decompensated heart failure treatmentAcute decompensated heart failurePressure reductionChronic oral medicationHeart failure admissionsHeart failure hospitalizationHeart failure treatmentSystolic blood pressureDiuretic doseImproved diuresisFailure hospitalizationOral medicationsFailure treatmentDiuresisFluid outputAdmission
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