2024
Mechanistic Differences between Torsemide and Furosemide.
Rao V, Cox Z, Ivey-Miranda J, Neville D, Balkcom N, Moreno-Villagomez J, Ramos-Mastache D, Maulion C, Bellumkonda L, Tang W, Collins S, Velazquez E, Mentz R, Wilson F, Turner J, Wilcox C, Ellison D, Fang J, Testani J. Mechanistic Differences between Torsemide and Furosemide. Journal Of The American Society Of Nephrology 2024 PMID: 39196651, DOI: 10.1681/asn.0000000000000481.Peer-Reviewed Original ResearchTorsemide groupDiuretic doseTubular site of actionHigher diuretic dosesDose of furosemideProportion of dosesOral furosemideSite of actionPrescribed doseNeurohormonal activationMechanistic substudyClinical outcomesPharmacodynamic advantagesKidney dysfunctionPharmacodynamic parametersKidney functionRandomized trialsNatriuresisTubular sitesFurosemideTorsemideDoseTRANSFORM-HFPlasma volumeBody weightSerial direct sodium removal in patients with heart failure and diuretic resistance
Rao V, Ivey‐Miranda J, Cox Z, Moreno‐Villagomez J, Ramos‐Mastache D, Neville D, Balkcom N, Asher J, Bellumkonda L, Bigvava T, Shaburishvili T, Bartunek J, Wilson F, Finkelstein F, Maulion C, Turner J, Testani J. Serial direct sodium removal in patients with heart failure and diuretic resistance. European Journal Of Heart Failure 2024, 26: 1215-1230. PMID: 38556717, DOI: 10.1002/ejhf.3196.Peer-Reviewed Original ResearchConceptsDiuretic resistanceCardiorenal syndromeHeart failureLoop diureticsDiuretic withdrawalHigh-dose loop diureticsN-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideGrowth differentiation factor 15Carbohydrate antigen 125Differentiation factor 15Sodium removalRandomized controlled studyCardiorenal parametersDiuretic doseSoluble ST2Natriuretic peptideMedian timeDiuretic responseKidney injuryPeritoneal membraneElectrolyte handlingKidney functionDiureticsInterleukin-6
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
2022
Renin-Angiotensin-Aldosterone System Activation and Diuretic Response in Ambulatory Patients With Heart Failure
Amatruda JG, Scherzer R, Rao VS, Ivey-Miranda JB, Shlipak MG, Estrella MM, Testani JM. Renin-Angiotensin-Aldosterone System Activation and Diuretic Response in Ambulatory Patients With Heart Failure. Kidney Medicine 2022, 4: 100465. PMID: 35620081, PMCID: PMC9127684, DOI: 10.1016/j.xkme.2022.100465.Peer-Reviewed Original ResearchDiuretic doseTotal reninDiuretic responseDiuretic resistanceFractional excretionHeart failureActive reninSystem activationRenin-angiotensin-aldosterone system activationHigher plasmaActive renin levelsAldosterone system activationLower diuretic efficiencyPlasma total reninRAAS inhibitor useChronic heart failureMultivariable-adjusted modelsHigh-quality trialsLow fractional excretionFurosemide equivalentsRAAS blockadeAldosterone levelsRAAS activationRenin levelsInhibitor use
2021
FGF-23 (Fibroblast Growth Factor-23) and Cardiorenal Interactions
Ivey-Miranda JB, Stewart B, Cox ZL, McCallum W, Maulion C, Gleason O, Meegan G, Amatruda JG, Moreno-Villagomez J, Mahoney D, Turner JM, Wilson FP, Estrella MM, Shlipak MG, Rao VS, Testani JM. FGF-23 (Fibroblast Growth Factor-23) and Cardiorenal Interactions. Circulation Heart Failure 2021, 14: e008385. PMID: 34689571, PMCID: PMC8782627, DOI: 10.1161/circheartfailure.121.008385.Peer-Reviewed Original ResearchConceptsFGF-23Cardiorenal interactionsHeart failureDiuretic resistanceSodium avidityNeurohormonal activationMultivariable analysisDistal tubular sodium reabsorptionLoop diuretic doseTubular sodium reabsorptionGlomerular filtration rateCardiorenal dysfunctionDiuretic doseDiuretic treatmentNT-proBNPFractional excretionDiuretic administrationSodium reabsorptionPeak diuresisFiltration rateCare centerUrine samplingAnimal modelsSerum chlorideDisease severity
2020
Venous 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 interactionsSafety 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 doseMechanisms of Diuretic Resistance Study: design and rationale
Cox ZL, Fleming J, Ivey‐Miranda J, Griffin M, Mahoney D, Jackson K, Hodson DZ, Thomas D, Gomez N, Rao VS, Testani JM. Mechanisms of Diuretic Resistance Study: design and rationale. ESC Heart Failure 2020, 7: 4458-4464. PMID: 32893505, PMCID: PMC7754741, DOI: 10.1002/ehf2.12949.Peer-Reviewed Original ResearchAcute decompensated heart failureDiuretic resistanceDiuretic responseUrine collectionCombination diuretic therapyLoop diuretic administrationLoop diuretic doseLoop diuretic resistanceDecompensated heart failureProspective patient cohortPhysical exam findingsSpot urine collectionADHF hospitalizationsDiuretic doseDiuretic therapyHF outcomesBaseline bloodCommon complicationPatient characteristicsProspective cohortHeart failureLoop diureticsDiuretic administrationUrine biomarkersExam findingsReal 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
Rapid and Accurate Assessment of Diuretic Response: Validation of an Equation to Predict Diuretic Induced Sodium Output Using a Spot Urine Sample
Griffin M, Struyk G, Fleming J, Shamlian P, Wycallis E, Pattoli M, Thomas A, Stewart B, Barnett J, Gomez N, Ivey-Miranda J, Rao V, Testani J. Rapid and Accurate Assessment of Diuretic Response: Validation of an Equation to Predict Diuretic Induced Sodium Output Using a Spot Urine Sample. Journal Of Cardiac Failure 2019, 25: s52-s53. DOI: 10.1016/j.cardfail.2019.07.148.Peer-Reviewed Original ResearchPoor diuretic responseSpot urine samplesNet fluid balanceDiuretic responseSodium excretionUrine collectionDiuretic administrationSodium outputValidation cohortWeight lossUrine samplesFluid balanceCumulative sodium excretionTypes of diureticsRoutine clinical practiceNet fluid lossAssessment of responseDiuretic doseDiuretic periodDiuretic therapyBladder dysfunctionLoop diureticsSpot urineMedical recordsClinical trialsBiomarkers of Intravascular and Extravascular Volume Overload: Associations with Parameters of Cardio-Renal Dysfunction
Gomez N, Stewart B, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. Biomarkers of Intravascular and Extravascular Volume Overload: Associations with Parameters of Cardio-Renal Dysfunction. Journal Of Cardiac Failure 2019, 25: s21. DOI: 10.1016/j.cardfail.2019.07.060.Peer-Reviewed Original ResearchIntravascular volume overloadCardio-renal dysfunctionExtravascular volume overloadNT-proBNPCA 125Volume overloadDiuretic efficiencyFluid overloadHeart failureUrinary kidney injury molecule-1Kidney injury molecule-1Higher NT-proBNPLoop diuretic dosePlasma NT-proBNPInjury molecule-1Median NT-proBNPCarbohydrate antigen 125Cardio-renal functionIntravascular fluid overloadExtravascular fluid overloadDiuretic doseIntravascular overloadLower eGFRSodium excretionUrine albuminFGF-23 and Cardio-Renal Interactions in Heart Failure
Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. FGF-23 and Cardio-Renal Interactions in Heart Failure. Journal Of Cardiac Failure 2019, 25: s23-s24. DOI: 10.1016/j.cardfail.2019.07.545.Peer-Reviewed Original ResearchCardio-renal dysfunctionFGF-23 levelsFGF-23NT-proBNPDiuretic responsivenessIL-6Outpatient heart failure (HF) patientsPlasma FGF-23 levelsFibroblast growth factor 23Adverse left ventricular remodelingCardio-renal interactionsHigher NT-proBNPTotal renin levelsPlasma IL-6Heart failure patientsRenal sodium retentionGrowth factor 23High plasma reninLeft ventricular remodelingInduction of inflammationStrong independent associationResults Higher levelsDiuretic doseNeurohormonal activationPhosphaturic hormoneSafety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot
Griffin M, Flemming J, Pattoli M, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Struyk G, Shamlian P, Mahoney D, Ivey-Miranda J, Ivey-Miranda J, Rao V, Testani J. Safety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot. Journal Of Cardiac Failure 2019, 25: s52. DOI: 10.1016/j.cardfail.2019.07.147.Peer-Reviewed Original ResearchDiuretic resistanceFurosemide equivalentsRenal functionBlood pressureHeart failureWeight lossHeart failure physiciansNon-randomized pilotTraditional diuretic therapyMajority of patientsSystolic blood pressureRapid dose escalationMaximum daily doseSpot urine samplesDiuretic doseDiuretic protocolDiuretic therapyDiuretic dosesHF patientsSodium excretionStarting doseElectrolyte abnormalitiesHospital daysDaily doseDose escalationUrine Growth Differentiation Factor-15 is Not an Independent Biomarker of Cardio-Renal Interactions in Patients with Heart Failure
Barnett J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. Urine Growth Differentiation Factor-15 is Not an Independent Biomarker of Cardio-Renal Interactions in Patients with Heart Failure. Journal Of Cardiac Failure 2019, 25: s21-s22. DOI: 10.1016/j.cardfail.2019.07.063.Peer-Reviewed Original ResearchGrowth differentiation factor 15Plasma GDF-15GDF-15Heart failureDiuretic efficiencyDifferentiation factor 15Independent predictorsFactor 15Urinary cystatin C levelsCardio-renal interactionsLoop diuretic doseWorse kidney functionGlomerular filtration rateCystatin C levelsDiuretic doseNT-proBNPSodium excretionDiabetic patientsFractional excretionKidney functionPrognostic valueIndependent biomarkerOutpatient settingStress-responsive biomarkersFiltration rateRenal 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