2021
Renal negative pressure treatment as a novel therapy for heart failure-induced renal dysfunction
Rao VS, Maulion C, Asher JL, Ivey-Miranda J, Cox ZL, Moreno-Villagomez J, Mahoney D, Turner JM, Wilson FP, Wilcox CS, Testani J. Renal negative pressure treatment as a novel therapy for heart failure-induced renal dysfunction. AJP Regulatory Integrative And Comparative Physiology 2021, 321: r588-r594. PMID: 34405731, DOI: 10.1152/ajpregu.00115.2021.Peer-Reviewed Original ResearchConceptsRenal plasma flowGlomerular filtration rateCongestive HFTubular pressureHeart failure hospitalizationPara-aminohippurate clearanceCentral venous pressureHigh fractional excretionNegative pressure therapyUrinary collecting systemNegative pressure treatmentSimilar diuresisFailure hospitalizationRenal dysfunctionCardiac tamponadeIothalamate clearanceFractional excretionRenal parametersKidney functionRenal congestionRenal responseRight kidneyVenous pressurePressure therapyControl kidneysEarly 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
2020
Real 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
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 lossTherapyChlorothiazideMetolazoneTolvaptanDiureticsInfusionCohortLoop diuretic resistance complicating acute heart failure
Cox ZL, Testani JM. Loop diuretic resistance complicating acute heart failure. Heart Failure Reviews 2019, 25: 133-145. PMID: 31520280, DOI: 10.1007/s10741-019-09851-9.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAcute DiseaseDiureticsDrug ResistanceHeart FailureHumansInfusions, IntravenousPractice Guidelines as TopicSodium Potassium Chloride Symporter InhibitorsConceptsLoop diuretic resistanceDiuretic resistanceHeart failureAcute heart failure hospitalizationMechanism-based classification systemAcute heart failureHeart failure hospitalizationOngoing clinical trialsUniversal clinical applicationDiuretic strategyFailure hospitalizationDiuretic efficacyClinical trialsWorse outcomesTreatment pathwaysAnatomical locationClinical applicationCurrent literatureResistance mechanismsCurrent best practiceOutcomesClassification systemLiterature reviewHospitalizationPatients
2017
An exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial
Hanberg JS, Tang WH, Wilson FP, Coca SG, Ahmad T, Brisco MA, Testani JM. An exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial. International Journal Of Cardiology 2017, 241: 277-282. PMID: 28392080, PMCID: PMC5471358, DOI: 10.1016/j.ijcard.2017.03.114.Peer-Reviewed Original ResearchConceptsHigh-dose loop diureticsDiuretic doseAggressive decongestionDose trialFluid outputLoop diureticsHigh-dose loop diuretic therapyDose-related adverse effectsAdverse effectsLoop diuretic doseLoop diuretic therapyHeart failure patientsNet fluid balanceNet fluid outputRate of deathEmergency department (ED) visitationPotential beneficial effectsHypothesis-generating observationsEffective decongestionDiuretic therapyFailure patientsAdverse outcomesDecongestive effectImproved outcomesFluid balance
2016
Relevance of Changes in Serum Creatinine During a Heart Failure Trial of Decongestive Strategies: Insights From the DOSE Trial
Brisco MA, Zile MR, Hanberg JS, Wilson FP, Parikh CR, Coca SG, Tang WH, Testani JM. Relevance of Changes in Serum Creatinine During a Heart Failure Trial of Decongestive Strategies: Insights From the DOSE Trial. Journal Of Cardiac Failure 2016, 22: 753-760. PMID: 27374839, PMCID: PMC5435117, DOI: 10.1016/j.cardfail.2016.06.423.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersCause of DeathCreatinineDisease ProgressionDisease-Free SurvivalDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Administration ScheduleFemaleFurosemideGlomerular Filtration RateHeart FailureHumansInfusions, IntravenousKidney Function TestsMaleMiddle AgedPrognosisSurvival RateTreatment OutcomeConceptsStable renal functionRenal functionComposite endpointDecongestive strategiesSerum creatinineDose trialAdverse outcomesClinical trialsSurrogate endpointsDiuretic Optimization Strategies Evaluation (DOSE) trialHeart failure clinical trialsHeart Failure TrialPoor prognostic signCoprimary endpointsComposite outcomeDecongestive therapyFailure TrialPrognostic signEmergency roomImproved outcomesLower riskCreatinineEndpointTrialsAbsence of risk
2015
Intravenous Fluids in Acute Decompensated Heart Failure
Bikdeli B, Strait KM, Dharmarajan K, Li SX, Mody P, Partovian C, Coca SG, Kim N, Horwitz LI, Testani JM, Krumholz HM. Intravenous Fluids in Acute Decompensated Heart Failure. JACC Heart Failure 2015, 3: 127-133. PMID: 25660836, PMCID: PMC4438991, DOI: 10.1016/j.jchf.2014.09.007.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCohort StudiesDatabases, FactualFemaleFluid TherapyHeart FailureHospital MortalityHospitalizationHumansInfusions, IntravenousIntensive Care UnitsIntubation, IntratrachealIsotonic SolutionsMaleMiddle AgedRenal Replacement TherapyRetrospective StudiesRinger's SolutionSaline Solution, HypertonicSodium Potassium Chloride Symporter InhibitorsUnited StatesYoung AdultConceptsAcute decompensated heart failureDecompensated heart failureHeart failureIntravenous fluidsRetrospective cohort studyCritical care admissionRenal replacement therapyDays of hospitalizationProportion of hospitalizationsHalf-normal salineWarrants further investigationOnly diureticsCare admissionHospital deathHospital outcomesCohort studyLoop diureticsPatient groupReplacement therapyWorse outcomesNormal salineInpatient careMedian volumePatientsHospitalizationSubstantial 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
2014
Insufficient Natriuretic Response to Continuous Intravenous Furosemide Is Associated With Poor Long-Term Outcomes in Acute Decompensated Heart Failure
Singh D, Shrestha K, Testani JM, Verbrugge FH, Dupont M, Mullens W, Tang WH. Insufficient Natriuretic Response to Continuous Intravenous Furosemide Is Associated With Poor Long-Term Outcomes in Acute Decompensated Heart Failure. Journal Of Cardiac Failure 2014, 20: 392-399. PMID: 24704538, PMCID: PMC4067259, DOI: 10.1016/j.cardfail.2014.03.006.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureContinuous intravenous furosemideDecompensated heart failureLong-term outcomesIntravenous furosemideNatriuretic responseRenal functionUrine sodiumHeart failureClinical outcomesUrine creatinineAdverse long-term clinical outcomesAdverse long-term outcomesLong-term clinical outcomesPoor long-term outcomesAdverse long-term eventsWeight lossContinuous furosemide infusionNet urine outputUrine sodium excretionAdverse clinical outcomesGlomerular filtration rateNet fluid outputGreater likelihoodLow urine sodium
2010
Characteristics of Patients With Improvement or Worsening in Renal Function During Treatment of Acute Decompensated Heart Failure
Testani JM, McCauley BD, Kimmel SE, Shannon RP. Characteristics of Patients With Improvement or Worsening in Renal Function During Treatment of Acute Decompensated Heart Failure. The American Journal Of Cardiology 2010, 106: 1763-1769. PMID: 21055713, PMCID: PMC2997119, DOI: 10.1016/j.amjcard.2010.07.050.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseCardiotonic AgentsCatheterization, Swan-GanzCreatinineDisease ProgressionFemaleFollow-Up StudiesGlomerular Filtration RateHeart FailureHumansInfusions, IntravenousMaleMiddle AgedPrognosisPulmonary Wedge PressureRecovery of FunctionRenal InsufficiencyRetrospective StudiesStroke VolumeVasodilator AgentsConceptsDecompensated heart failureRenal functionStable renal functionCardiac indexHeart failureVasodilator usePulmonary Artery Catheterization Effectiveness trialAcute decompensated heart failureSimilar hemodynamic parametersCharacteristics of patientsCongestive heart failureComparison of patientsAdvanced disease stateCardiorenal interactionsIntravenous inotropesCause mortalityWorse survivalHemodynamic variablesPoor prognosisCreatinine valuesEffectiveness trialHemodynamic parametersHemodynamic differencesPatientsDisease states