2022
Evidence-Based Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease
Beldhuis IE, Lam CSP, Testani JM, Voors AA, Van Spall HGC, Maaten J, Damman K. Evidence-Based Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease. Circulation 2022, 145: 693-712. PMID: 35226558, PMCID: PMC9074837, DOI: 10.1161/circulationaha.121.052792.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsChronic kidney diseasePresence of CKDSevere chronic kidney diseaseHeart failure hospitalizationReduced ejection fractionHFrEF therapyHeart failureFailure hospitalizationEjection fractionMedical therapyKidney diseaseDrug classesSodium-glucose cotransporter 2 inhibitorsEvidence-based medical therapyGlucose cotransporter 2 inhibitorsStrong independent risk factorEnd pointCKD stage 3bPoor cardiovascular outcomesCKD stage 5Combined end pointCotransporter 2 inhibitorsIndependent risk factorSevere heart failureGlomerular filtration rate
2019
Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure
Griffin M, Rao VS, Fleming J, Raghavendra P, Turner J, Mahoney D, Wettersten N, Maisel A, Ivey-Miranda JB, Inker L, Tang WHW, Wilson FP, Testani JM. Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure. The American Journal Of Cardiology 2019, 124: 1707-1711. PMID: 31601358, PMCID: PMC6959849, DOI: 10.1016/j.amjcard.2019.08.034.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureHeart failureImproved survivalHigher loop diuretic dosesLoop diuretic dosesNet fluid lossPlasma volume reductionAggressive decongestionAggressive diuresisPostdischarge survivalDiuretic dosesPostdischarge outcomesSerum creatinineHospital treatmentHospital parametersBetter survivalCreatinineHemoconcentrationPatient carePatientsSurvivalLonger lengthVolume reductionTreatmentNatriuretic 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
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
2017
Novel Biomarkers for the Risk Stratification of Heart Failure with Preserved Ejection Fraction
Cypen J, Ahmad T, Testani JM, DeVore AD. Novel Biomarkers for the Risk Stratification of Heart Failure with Preserved Ejection Fraction. Current Heart Failure Reports 2017, 14: 434-443. PMID: 28803400, DOI: 10.1007/s11897-017-0358-4.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsHeart failureEjection fractionHF biomarkersRisk stratificationReduced ejection fractionTreatment of HFpEFBrain natriuretic peptideValuable prognostic markerKey pathophysiologic componentUse of biomarkersSignificant therapeutic targetSystemic inflammationPathophysiologic componentsNatriuretic peptidePrognostic valueMyocardial fibrosisPrognostic markerNovel biomarkersCurrent evidenceTherapeutic targetHFpEFReviewThe useSummaryFurther investigationBiomarkersInflammation
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
Familial dilated cardiomyopathy diagnosis is commonly overlooked at the time of transplant listing
Seidelmann SB, Laur O, Hwa J, Depasquale E, Bellumkonda L, Sugeng L, Pomianowski P, Testani J, Chen M, McKenna W, Jacoby D. Familial dilated cardiomyopathy diagnosis is commonly overlooked at the time of transplant listing. The Journal Of Heart And Lung Transplantation 2015, 35: 474-480. PMID: 26852066, PMCID: PMC5423783, DOI: 10.1016/j.healun.2015.12.002.Peer-Reviewed Original ResearchConceptsEnd-stage heart failureStage heart failureHeart failureUNOS registryEchocardiographic findingsUNOS databaseTeaching hospitalDetailed pedigree analysisVentricular end-diastolic dimensionPanel reactive antibody levelsTertiary care teaching hospitalLarge tertiary teaching hospitalCenter-specific dataAdvanced heart failureEnd-diastolic dimensionOrgan Sharing registryMajority of patientsNon-ischemic DCMTertiary teaching hospitalMitral valve annulusDetailed family historyTransplant listingAdult patientsClinical characteristicsUNOS dataDiuretic 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-HFSubstantial 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 nitrogenHospital Variation in Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure
Kulkarni VT, Kim N, Dai Y, Dharmarajan K, Safavi KC, Bikdeli B, Lindenauer PK, Testani J, Dries DL, Krumholz HM. Hospital Variation in Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure. Circulation Heart Failure 2014, 7: 427-433. PMID: 24633829, PMCID: PMC4386575, DOI: 10.1161/circheartfailure.113.000698.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureNoninvasive positive pressure ventilationDecompensated heart failureRisk-standardized mortality ratesPositive pressure ventilationHeart failureIntubation rateMortality ratePressure ventilationUse of NPPVHospital risk-standardized mortality ratesHigher intubation rateHospital practice patternsHospital-level outcomesCross-sectional studyHierarchical logistic regression modelsLogistic regression modelsNIPPV useHospital variationSuch hospitalizationsPractice patternsHospitalizationHospitalQuartileBottom quartile
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 admissionsPrevalence and Prognostic Importance of Changes in Renal Function After Mechanical Circulatory Support
Brisco MA, Kimmel SE, Coca SG, Putt ME, Jessup M, Tang WW, Parikh CR, Testani JM. Prevalence and Prognostic Importance of Changes in Renal Function After Mechanical Circulatory Support. Circulation Heart Failure 2013, 7: 68-75. PMID: 24214901, PMCID: PMC4067252, DOI: 10.1161/circheartfailure.113.000507.Peer-Reviewed Original ResearchConceptsMechanical circulatory supportRenal functionCirculatory supportEarly improvementContinuous-flow devicesMechanically Assisted Circulatory SupportLarge multicenter populationSerial creatinine levelsGlomerular filtration rateMajority of patientsMulticenter populationCause mortalityInteragency RegistryAdult patientsCreatinine levelsPrognostic importancePrognostic significanceImproved prognosisFiltration ratePoor survivalSurvival disadvantageEGFRPatientsAdditional researchMechanistic basisInfluence of Age-Related Versus Non–Age-Related Renal Dysfunction on Survival in Patients With Left Ventricular Dysfunction
Testani JM, Brisco MA, Han G, Laur O, Kula AJ, Cheng SJ, Tang WH, Parikh CR. Influence of Age-Related Versus Non–Age-Related Renal Dysfunction on Survival in Patients With Left Ventricular Dysfunction. The American Journal Of Cardiology 2013, 113: 127-131. PMID: 24216124, PMCID: PMC3915785, DOI: 10.1016/j.amjcard.2013.09.029.Peer-Reviewed Original ResearchConceptsLow glomerular filtration rateGlomerular filtration rateVentricular dysfunctionRenal dysfunctionNormal agingLeft ventricular dysfunctionRisk of deathNormal aging resultsAge-related decreaseInfluence of ageBaseline eGFRMean eGFRLower eGFRWorsened survivalPrognostic importanceFiltration rateSurvival disadvantagePrimary analysisDysfunctionEGFRSignificant riskPatientsUnderlying mechanismRiskMortality
2011
Prognostic Importance of Early Worsening Renal Function After Initiation of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Cardiac Dysfunction
Testani JM, Kimmel SE, Dries DL, Coca SG. Prognostic Importance of Early Worsening Renal Function After Initiation of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Cardiac Dysfunction. Circulation Heart Failure 2011, 4: 685-691. PMID: 21903907, PMCID: PMC3248247, DOI: 10.1161/circheartfailure.111.963256.Peer-Reviewed Original ResearchConceptsGlomerular filtration rateRenal functionPrognostic significanceAngiotensin-Converting Enzyme Inhibitor TherapyACE-I therapySetting of angiotensinWorsening Renal FunctionEnzyme inhibitor therapyPrimary end pointAdverse prognostic significanceEnalapril groupEnalapril therapyPlacebo groupStudy drugVentricular dysfunctionHeart failureInhibitor therapyCardiac dysfunctionPrognostic importanceFiltration rateSurvival advantageMortality rateOverall populationEnd pointTherapyImpact 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