2024
Increased Spironolactone Dosing in Acute Heart Failure Alters Potassium Homeostasis but Does not Enhance Decongestion
Natov P, Ivey-Miranda J, Cox Z, Rao V, Butler J, Konstam M, Kiernan M, Kapur N, Testani J. Increased Spironolactone Dosing in Acute Heart Failure Alters Potassium Homeostasis but Does not Enhance Decongestion. Journal Of Cardiac Failure 2024, 30: 1522-1526. PMID: 38986838, DOI: 10.1016/j.cardfail.2024.06.008.Peer-Reviewed Original ResearchBaseline serum potassiumAcute heart failureSerum potassiumSpironolactone treatmentTreatment armsHeart failureBaseline serum potassium levelsNatriuretic peptide levelsTreated with spironolactoneSerum potassium levelsSpironolactone-treated patientsNet fluid lossRenal potassium handlingPost hoc analysisEnhance decongestionSpironolactone dosePotassium wastingUrine outputClinical congestionTreatment startPotassium handlingPotassium replacementPotassium supplementationPharmacodynamic effectsSurrogate marker
2023
In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility
Ivey-Miranda J, Rao V, Cox Z, Moreno-Villagomez J, Mahoney D, Maulion C, Bellumkonda L, Turner J, Collins S, Wilson F, Krumholz H, Testani J. In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility. Circulation Heart Failure 2023, 16: e010206. PMID: 36896716, PMCID: PMC10186250, DOI: 10.1161/circheartfailure.122.010206.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureDiuretic responseDiuretic dosingOral diureticsHeart failureMulticenter cohortHospital observationLower readmission ratesNet fluid balanceDays postdischargeReadmission ratesHospital readmissionUrine outputReadmission riskFluid statusFluid balanceHospital measuresDose selectionCohortProvider decisionsWeight changeReadmissionDiureticsPatientsImprovement in Renal Function During the Treatment of Acute Decompensated Heart Failure: Relationship With Markers of Renal Tubular Injury and Prognostic Importance
Natov P, Ivey-Miranda J, Cox Z, Moreno-Villagomez J, Maulion C, Bellumkonda L, Shlipak M, Estrella M, Borlaug B, Rao V, Testani J. Improvement in Renal Function During the Treatment of Acute Decompensated Heart Failure: Relationship With Markers of Renal Tubular Injury and Prognostic Importance. Circulation Heart Failure 2023, 16: e009776. PMID: 36700431, PMCID: PMC10150783, DOI: 10.1161/circheartfailure.122.009776.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureStable renal functionGlomerular filtration rateRenal functionRenal tubular injuryHeart failureTubular injuryKIM-1Filtration rateRenal tubular injury markersTubular injury markersRenal function groupCumulative urine outputCardiorenal dysfunctionDiuretic dosesInjury markersWorse survivalWorsened survivalUrine outputDecongestive therapyPrognostic importanceAdverse outcomesLower admissionPatients
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 discrimination
2020
Safety and Efficacy of an Automated Nurse-Driven Diuretic Titration Protocol: the Yale Diuretic Pathway
Meegan G, Sangkachand P, O'Brien M, Riello R, Soucier R, Jacoby D, Gleason O, Fleming J, Griffin M, Ivey-Miranda J, Cox Z, Rao V, Testani J. Safety and Efficacy of an Automated Nurse-Driven Diuretic Titration Protocol: the Yale Diuretic Pathway. Journal Of Cardiac Failure 2020, 26: s22. DOI: 10.1016/j.cardfail.2020.09.070.Peer-Reviewed Original ResearchAcute decompensated heart failureDiuretic doseLoop diureticsSodium outputBlood pressureEMR orderTitration protocolDecompensated heart failureSystolic blood pressureDaily urine outputSpot urine samplesNet fluid outputDiuretic resistanceFurosemide equivalentsFirst doseMedian doseSodium excretionHeart failureSerum potassiumSubsequent dosesUrine outputClinical outcomesMedian timeSerum magnesiumSame doseValidation of Natriuretic Response Prediction Equation in Patients with Acute Decompensated Heart Failure
Gleason O, Meegan G, Fleming J, Griffin M, Ivey-Miranda J, Cox Z, Rao V, Testani J. Validation of Natriuretic Response Prediction Equation in Patients with Acute Decompensated Heart Failure. Journal Of Cardiac Failure 2020, 26: s2. DOI: 10.1016/j.cardfail.2020.09.015.Peer-Reviewed Original ResearchNatriuretic responseSodium outputUrine collectionDiuretic administrationAcute decompensated heart failureIntravenous loop diuretic therapyLoop diuretic administrationLoop diuretic therapySpot urine sodiumDecompensated heart failureHeart failure admissionsRoutine clinical practiceSpot urine samplesNet fluid outputTotal sodium excretionUrine spot samplesADHF patientsDiuretic therapySodium excretionUrine sodiumHeart failureLoop diureticsUrine outputClinical practiceFluid outputRenal Negative Pressure Treatment as a Novel Therapy for Cardio-Renal Syndrome
Maulion C, Asher J, Moskow J, Ivey-Miranda J, Fleming J, Gleason O, Meegan G, Rao V, Testani J. Renal Negative Pressure Treatment as a Novel Therapy for Cardio-Renal Syndrome. Journal Of Cardiac Failure 2020, 26: s6-s7. DOI: 10.1016/j.cardfail.2020.09.027.Peer-Reviewed Original ResearchUrine outputNegative pressure treatmentCreatinine clearanceLoop diureticsTubular pressureAcute decompensated heart failure hospitalizationHF inductionElevated filling pressuresHigh-dose furosemidePrimary therapeutic objectiveCardio-renal syndromeHeart failure hospitalizationHeart failure modelUrinary collecting systemStable cardiac outputDose furosemideCardiac tamponadeFailure hospitalizationSodium excretionHemodynamic profileRenal functionKidney functionR kidneysSwan-GanzCardiac outputVenous Congestion, Not Cardiac Index is Associated with Diuretic Resistance
Eder M, Griffin M, Fleming J, Gleason O, Meegan G, Ivey-Miranda J, Cox Z, Rao V, Testani J. Venous Congestion, Not Cardiac Index is Associated with Diuretic Resistance. Journal Of Cardiac Failure 2020, 26: s30-s31. DOI: 10.1016/j.cardfail.2020.09.095.Peer-Reviewed Original ResearchRight atrial pressureBaseline right atrial pressureAcute decompensated heart failureCardiac indexLow cardiac indexDiuretic efficiencyMin/m2Daily urine outputDiuretic resistanceUrine outputDiuretic responseVenous congestionDiuretic doseHeart failureDE groupHigher baseline right atrial pressureHigher right atrial pressureElevated right atrial pressureBaseline cardiac indexLoop diuretic doseDecompensated heart failureCongestive heart failureSubset of patientsGreater diuretic responseCardiorenal interactionsSodium 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
Prevalence of Bladder Dysfunction in Acute Decompensated Heart Failure
Thomas A, Gomez N, Stewart B, Barnett J, Wycallis E, Pattoli M, Struyk G, Shamlian P, Fleming J, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. Prevalence of Bladder Dysfunction in Acute Decompensated Heart Failure. Journal Of Cardiac Failure 2019, 25: s67. DOI: 10.1016/j.cardfail.2019.07.191.Peer-Reviewed Original ResearchAcute decompensated heart failureDecompensated heart failureBladder dysfunctionHeart failurePost-void residual volumeYale-New Haven HospitalPrimary therapeutic objectiveSignificant bladder dysfunctionVoid residual volumeAcute urinary retentionNew Haven HospitalADHF patientsNormal PVRUrinary retentionBladder ultrasoundDiabetic statusMethods PatientsOutpatient followPVR volumeUrine outputVolume overloadBladder scanResidual volumeUnderwent determinationBladder scannerRenal Diuretic Delivery is Highly Variable in Hospitalized Decompensated Heart Failure Patients and Associated with Diuretic Resistance
Wycallis E, Stewart B, Ivey-Miranda J, Griffin M, Gomez N, Thomas A, Barnett J, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Rao V, Cox Z, Testani J. Renal Diuretic Delivery is Highly Variable in Hospitalized Decompensated Heart Failure Patients and Associated with Diuretic Resistance. Journal Of Cardiac Failure 2019, 25: s3. DOI: 10.1016/j.cardfail.2019.07.018.Peer-Reviewed Original ResearchLoop diureticsADHF patientsTubular sitesRenal perfusionSite of actionRenal urea handlingDecompensated heart failure patientsYale-New Haven HospitalGood urine outputHospitalized ADHF patientsNT-proBNP levelsHeart failure patientsRoute of administrationNew Haven HospitalUrea handlingDiuretic doseDiuretic resistanceFurosemide equivalentsSolute handlingRenal dysfunctionBlood pressureEjection fractionFailure patientsFractional excretionUrine output