2021
Natriuretic 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 discriminationThe Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study
Moledina DG, Simonov M, Yamamoto Y, Alausa J, Arora T, Biswas A, Cantley LG, Ghazi L, Greenberg JH, Hinchcliff M, Huang C, Mansour SG, Martin M, Peixoto A, Schulz W, Subair L, Testani JM, Ugwuowo U, Young P, Wilson FP. The Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study. American Journal Of Kidney Diseases 2021, 77: 490-499.e1. PMID: 33422598, PMCID: PMC7791318, DOI: 10.1053/j.ajkd.2020.12.007.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAgedCohort StudiesCOVID-19C-Reactive ProteinCreatinineDiureticsFemaleHospital MortalityHumansIntensive Care UnitsLength of StayMaleMiddle AgedProportional Hazards ModelsRenal DialysisRenal Insufficiency, ChronicRespiration, ArtificialRisk FactorsSARS-CoV-2Severity of Illness IndexUnited StatesVasoconstrictor AgentsConceptsAcute kidney injurySARS-CoV-2Cohort studyRisk factorsCOVID-19Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testingTime-updated Cox proportional hazards modelsDialysis-requiring acute kidney injuryYale New Haven Health SystemHigher inflammatory marker levelsMore acute kidney injuryCox proportional hazards modelMulticenter cohort studyHigh rateInflammatory marker levelsTraditional risk factorsProportional hazards modelCoronavirus disease 2019KDIGO criteriaNephrotoxin exposureKidney injuryInjury independentUnivariable analysisNasopharyngeal samplesMarker levels
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 output
2018
The prognostic role of different renal function phenotypes in patients with acute heart failure
Palazzuoli A, Ruocco G, Pellicori P, Incampo E, Di Tommaso C, Favilli R, Evangelista I, Nuti R, Testani JM. The prognostic role of different renal function phenotypes in patients with acute heart failure. International Journal Of Cardiology 2018, 276: 198-203. PMID: 30503187, DOI: 10.1016/j.ijcard.2018.11.108.Peer-Reviewed Original ResearchConceptsAcute heart failureBUN increaseHeart failureIndependent predictorsPrognostic roleAdverse outcomesGlomerular filtration rate reductionBlood nitrogen ureaSigns of HFRenal function deteriorationBUN changeClinical congestionEffective decongestionFunction deteriorationRenal functionSerum creatininePoor outcomePrognostic relevanceComplete resolutionClinical signsPatientsNitrogen ureaHospitalizationBUNOutcomesHemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure
Grodin JL, Mullens W, Dupont M, Taylor DO, McKie PM, Starling RC, Testani JM, Tang WHW. Hemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure. International Journal Of Cardiology 2018, 252: 112-116. PMID: 29249420, DOI: 10.1016/j.ijcard.2017.11.024.Peer-Reviewed Original ResearchConceptsPulmonary capillary wedge pressureAdvanced chronic heart failureFick cardiac indexPulmonary artery systolic pressureRight atrial pressureVentricular assist device placementHeart transplantHeart rateHeart failureSerum chlorideHigher cardiac filling pressuresPoor long-term outcomesSerum Cl levelsCapillary wedge pressureCardiac filling pressuresChronic heart failureAdvanced heart failureInvasive hemodynamic assessmentHeart failure patientsRisk of deathLong-term outcomesLower serum chlorideConventional clinical parametersBackward regression modelAssociation of hemodynamics
2015
Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure
Grodin JL, Simon J, Hachamovitch R, Wu Y, Jackson G, Halkar M, Starling RC, Testani JM, Tang WH. Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure. Journal Of The American College Of Cardiology 2015, 66: 659-666. PMID: 26248993, DOI: 10.1016/j.jacc.2015.06.007.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersChloridesCohort StudiesFemaleFollow-Up StudiesHeart FailureHumansMaleMiddle AgedMortalityPrognosisConceptsAcute decompensated heart failureSerum chloride levelsDecompensated heart failureSerum sodium levelsHeart failureSodium levelsADHF cohortMultivariable risk-adjusted analysisMultivariable risk adjustmentChronic heart failureLong-term mortalityRisk-adjusted analysisChloride levelsElectrolyte abnormalitiesConsecutive patientsPrognostic roleSerum sodiumPrognostic significancePrognostic valueValidation cohortCleveland ClinicClinical significanceRisk adjustmentCohortMortalityIntravenous 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
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 nitrogenInsufficient 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
2013
Biochemical 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 diuresis
2011
Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials
Testani JM, Coca SG, Shannon RP, Kimmel SE, Cappola TP. Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. European Journal Of Heart Failure 2011, 13: 1224-1230. PMID: 21926073, PMCID: PMC3200208, DOI: 10.1093/eurjhf/hfr123.Peer-Reviewed Original ResearchConceptsGlomerular filtration rateBUN/creatinineRenal insufficiencyNeurohormonal activationRisk of mortalityHeart failurePulmonary Artery Catheterization Effectiveness trialLeft Ventricular Dysfunction (SOLVD) trialBaseline renal insufficiencyBeta-Blocker EvaluationVentricular Dysfunction trialsHeart failure populationCongestive heart failureBlood urea nitrogenCreatinine ratioPrimary outcomeCardiac dysfunctionFailure populationFiltration rateEffectiveness trialPoor survivalStudy populationUrea nitrogenPatientsMortality
2010
Effect 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