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. 2020 Sep 11;9(9):2932.
doi: 10.3390/jcm9092932.

Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation

Mauro Feola  1 , Arianna Rossi  2 , Marzia Testa  1 , Cinzia Ferreri  1 , Alberto Palazzuoli  3 , Guido Pastorini  1 , Gaetano Ruocco  1
Affiliations

Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation

Mauro Feola et al. J Clin Med. .

Erratum in

Abstract

Background: The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes.

Methods: Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events.

Results: 263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function (p = 0.001), a higher NT-proBNP (p = 0.001), a lower left ventricular ejection fraction (p = 0.01), DR (p = 0.02) and R-to-D (p = 0.03). Spearman rho's correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; p < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; p < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; p < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome (p = 0.04 and p = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = -0.23; p = 0.01).

Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.

Keywords: NT-proBNP; diuretic resistance; heart failure; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Receiving operating characteristics (ROC) curve analysis comparing diuretic response (DR) and response to diuretic (R-to-D). AUC, area under curve; CI, confidence interval.
Figure 2
Figure 2
Statistical differences of diuretic response (DR) or response to diuretic (R-to-D) according to the heart failure (HF) classification of reduced/preserved ejection fraction. DR: 1.60 (0.72–3.38) vs. 1315 (0.60–2.24); all patients: 1.44 (0.67–2.80). R to D: 1.95 (1.01–3.75) vs. 1605 (0.94–2.61); all patients: 1.69 (0.97–3.28). HFpEF—heart failure with preserved ejection fraction; HFrEF —heart failure with reduced ejection fraction.
Figure 3
Figure 3
Spearman rho’s correlation between diuretic response (DR) or response to diuretic (R-to-D) in the entire population (263 pts) and both in HFrEF or HFpEF.
See this image and copyright information in PMC

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