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1.
目的研究口服袢利尿剂剂量与慢性心力衰竭(心衰)患者全因死亡率的关系。方法入选并随访1197例(1120例获得用药资料)慢性心衰患者.男性占81.7%,平均年龄56.5±13.6岁,平均左室射血分数(LVEF)35.6±8.9%;全因死亡为随访终点。先比较不同口服袢利尿剂剂量(0、≤20、20~40、>40mg/日呋塞米当量)人群其他预后相关因素分布的差异,再应用Kaplan-Meier曲线及Log-rank检验对不同剂量人群的生存率进行描述及比较,多元Cox回归用于分析口服袢利尿剂剂量是否为心衰死亡的独立预测因子。结果完成随访1025例(失访率14.4%),死亡360例(35.1%);随访中位数44个月。平均袢利尿剂剂量34.26±2.67mg/日呋塞米当量。应用不同袢利尿剂剂量的心衰患者在合并症、血压、LVEF、多种检验项目及用药方面存在显著差异。不同剂量心衰人群的死亡率分别为19.2%、29.6%、39.8%及55.4%,随着袢利尿剂应用剂量增加而增高(P<0.001);校正其他影响因素后,口服袢利尿剂剂量与心衰患者不良预后独立相关。剂量每增加10mg/日呋塞米当量,心衰死亡风险增加1.072倍(P<0.001)。服用≤20mg/日、20-40mg/日及>40mg/日呋塞米当量心衰人群的死亡风险分别是未服用者的1.575倍(P=0.023)、1.958倍(P=0.001)及2.543倍(P<0.001)。结论虽然年龄、体重指数、LVEF、合并室速、是否应用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂、应用袢利尿剂剂量、血红蛋白、总胆红素、尿酸均与心衰预后相关。应用袢利尿剂且随着剂量增加,心衰的死亡风险增高。 相似文献
2.
Jan Biegus Robert Zymliński Jeffrey Testani Marat Fudim Zachary L. Cox Mateusz Guzik Gracjan Iwanek Magdalena Hurkacz Danuta Raj Dominik Marciniak Barbara Ponikowska Piotr Ponikowski 《European journal of heart failure》2023,25(8):1323-1333
Aims
Diuretic response in heart failure is blunted when compared to healthy individuals, but the pathophysiology underlying this phenomenon is unclear. We aimed to investigate whether the diuretic resistance mechanism is related to insufficient furosemide tubular delivery or low tubular responsiveness.Methods and results
We conducted a prospective, observational study of 50 patients with acute heart failure patients divided into two groups based on previous furosemide use (furosemide naïve: n = 28 [56%] and chronic furosemide users: n = 22 [44%]). Each patient received a protocol-derived, standardized furosemide dose based on body weight. We measured diuretic response and urine furosemide concentrations. The furosemide naïve group had significantly higher urine volumes and natriuresis when compared to chronic users at all timepoints (all p < 0.05). Urine furosemide delivery was similar in furosemide naïve versus chronic users after accounting for differences in estimated glomerular filtration rate (28.02 [21.03–35.89] vs. 29.70 [18.19–34.71] mg, p = 0.87). However, the tubular response to delivered diuretic was dramatically higher in naïve versus chronic users, that is the urine volume per 1 μg/ml of urine furosemide at 2 h was 148.6 ± 136.1 versus 50.6 ± 56.1 ml (p = 0.005).Conclusions
Patients naïve to furosemide have significantly better diuresis and natriuresis when compared to chronic furosemide users. The blunted diuretic response in patients with chronic loop diuretic exposure is driven by decreased tubular responsiveness rather than insufficient furosemide tubular delivery. 相似文献3.
Patrick Rossignol Mitja Lainscak Maria G. Crespo‐Leiro Ccile Laroche Massimo F. Piepoli Gerasimos Filippatos Giuseppe M.C. Rosano Gianluigi Savarese Stefan D. Anker Petar M. Seferovic Frank Ruschitzka Andrew J.S. Coats Alexandre Mebazaa Theresa McDonagh Ana Sahuquillo Maria Penco Aldo P. Maggioni Lars H. Lund 《European journal of heart failure》2020,22(8):1378-1389
4.
Marija Polovina Marisa G. Crespo‐Leiro Lars H. Lund Stefan D. Anker Cécile Laroche Roberto Ferrari Andrew J.S. Coats Theresa McDonagh Gerasimos Filippatos Aldo P. Maggioni Massimo F. Piepoli Giuseppe M.C. Rosano Frank Ruschitzka Dragan Simi? Milika A?anin Jean‐Christophe Eicher Mehmet B. Yilmaz Petar M. Seferovi? 《European journal of heart failure》2020,22(1):92-102
5.
Long‐term safety of intravenous cardiovascular agents in acute heart failure: results from the European Society of Cardiology Heart Failure Long‐Term Registry
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Alexandre Mebazaa Justina Motiejunaite Etienne Gayat Maria G. Crespo‐Leiro Lars H. Lund Aldo P. Maggioni Ovidiu Chioncel Eiichi Akiyama Veli‐Pekka Harjola Petar Seferovic Cecile Laroche Marisa Sanz Julve Eulalia Roig Frank Ruschitzka Gerasimos Filippatos 《European journal of heart failure》2018,20(2):332-341
6.
In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the ESC‐HFA Heart Failure Long‐Term Registry
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Giovanni Targher Marco Dauriz Cécile Laroche Pier Luigi Temporelli Mahmoud Hassanein Petar M. Seferovic Jaroslaw Drozdz Roberto Ferrari Stephan Anker Andrew Coats Gerasimos Filippatos Maria G. Crespo‐Leiro Alexandre Mebazaa Massimo F. Piepoli Aldo Pietro Maggioni Luigi Tavazzi 《European journal of heart failure》2017,19(1):54-65
7.
Agnieszka Kapłon-Cieślicka Lina Benson Ovidiu Chioncel Maria G. Crespo-Leiro Andrew J.S. Coats Stefan D. Anker Frank Ruschitzka Camilla Hage Jarosław Drożdż Petar Seferovic Giuseppe M.C. Rosano Massimo Piepoli Alexandre Mebazaa Theresa McDonagh Mitja Lainscak Gianluigi Savarese Roberto Ferrari Wilfried Mullens Antoni Bayes-Genis Aldo P. Maggioni Lars H. Lund on behalf of the Heart Failure Association of the European Society of Cardiology the ESC Heart Failure Long-Term Registry Investigators 《European journal of heart failure》2023,25(9):1571-1583
Aims
To comprehensively assess hyponatraemia in acute heart failure (AHF) regarding prevalence, associations, hospital course, and post-discharge outcomes.Methods and results
Of 8298 patients in the European Society of Cardiology Heart Failure Long-Term Registry hospitalized for AHF with any ejection fraction, 20% presented with hyponatraemia (serum sodium <135 mmol/L). Independent predictors included lower systolic blood pressure, estimated glomerular filtration rate (eGFR) and haemoglobin, along with diabetes, hepatic disease, use of thiazide diuretics, mineralocorticoid receptor antagonists, digoxin, higher doses of loop diuretics, and non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers. In-hospital death occurred in 3.3%. The prevalence of hyponatraemia and in-hospital mortality with different combinations were: 9% hyponatraemia both at admission and discharge (hyponatraemia Yes/Yes, in-hospital mortality 6.9%), 11% Yes/No (in-hospital mortality 4.9%), 8% No/Yes (in-hospital mortality 4.7%), and 72% No/No (in-hospital mortality 2.4%). Correction of hyponatraemia was associated with improvement in eGFR. In-hospital development of hyponatraemia was associated with greater diuretic use and worsening eGFR but also more effective decongestion. Among hospital survivors, 12-month mortality was 19% and adjusted hazard ratios (95% confidence intervals) were for hyponatraemia Yes/Yes 1.60 (1.35–1.89), Yes/No 1.35 (1.14–1.59), and No/Yes 1.18 (0.96–1.45). For death or heart failure hospitalization they were 1.38 (1.21–1.58), 1.17 (1.02–1.33), and 1.09 (0.93–1.27), respectively.Conclusion
Among patients with AHF, 20% had hyponatraemia at admission, which was associated with more advanced heart failure and normalized in half of patients during hospitalization. Admission hyponatraemia (possibly dilutional), especially if it did not resolve, was associated with worse in-hospital and post-discharge outcomes. Hyponatraemia developing during hospitalization (possibly depletional) was associated with lower risk. 相似文献8.
Hasselblad V Gattis Stough W Shah MR Lokhnygina Y O'Connor CM Califf RM Adams KF 《European journal of heart failure》2007,9(10):1064-1069
BACKGROUND: We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients. METHODS: In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background. RESULTS: Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values <0). Weight loss and maximum in-hospital dose were correlated (p=0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p=0.003), especially at >300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r=0.043; p=0.412) CONCLUSIONS: High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome. 相似文献
9.
Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long‐Term Registry
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Ovidiu Chioncel Alexandre Mebazaa Veli‐Pekka Harjola Andrew J. Coats Massimo Francesco Piepoli Maria G. Crespo‐Leiro Cecile Laroche Petar M. Seferovic Stefan D. Anker Roberto Ferrari Frank Ruschitzka Silvia Lopez‐Fernandez Daniela Miani Gerasimos Filippatos Aldo P. Maggioni 《European journal of heart failure》2017,19(10):1242-1254
10.
Wilfried Mullens Kevin Damman Veli‐Pekka Harjola Alexandre Mebazaa Hans‐Peter Brunner‐La Rocca Pieter Martens Jeffrey M. Testani W.H. Wilson Tang Francesco Orso Patrick Rossignol Marco Metra Gerasimos Filippatos Petar M. Seferovic Frank Ruschitzka Andrew J. Coats 《European journal of heart failure》2019,21(2):137-155
11.
12.
Stefan D. Anker Aldo P. Maggioni Andrew J. Coats Gerasimos Filippatos Frank Ruschitzka Roberto Ferrari Massimo Francesco Piepoli Juan F. Delgado Jimenez Marco Metra Candida Fonseca Jaromir Hradec Offer Amir Damien Logeart Ulf Dahlstr?m Bela Merkely Jaroslaw Drozdz Eva Goncalvesova Mahmoud Hassanein Ovidiu Chioncel Mitja Lainscak Petar M. Seferovic Dimitris Tousoulis Ausra Kavoliuniene Friedrich Fruhwald Emir Fazlibegovic Ahmet Temizhan Plamen Gatzov Andrejs Erglis Cécile Laroche Alexandre Mebazaa 《European journal of heart failure》2016,18(6):613-625
13.
Aldo P. Maggioni Ulf Dahlstrm Gerasimos Filippatos Ovidiu Chioncel Marisa Crespo Leiro Jaroslaw Drozdz Friedrich Fruhwald Lars Gullestad Damien Logeart Marco Metra John Parissis Hans Persson Piotr Ponikowski Mathias Rauchhaus Adriaan Voors Olav Wendelboe Nielsen Faiez Zannad Luigi Tavazzi 《European journal of heart failure》2010,12(10):1076-1084
14.
Ovidiu Chioncel Alexandre Mebazaa Aldo P. Maggioni Veli‐Pekka Harjola Giuseppe Rosano Cecile Laroche Massimo F. Piepoli Maria G. Crespo‐Leiro Mitja Lainscak Piotr Ponikowski Gerasimos Filippatos Frank Ruschitzka Petar Seferovic Andrew J.S. Coats Lars H. Lund 《European journal of heart failure》2019,21(11):1338-1352
15.
Characteristics,treatments and 1‐year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long‐Term Registry
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Marco Canepa Ewa Straburzynska‐Migaj Jaroslaw Drozdz Carla Fernandez‐Vivancos Jose Manuel Garcia Pinilla Noemi Nyolczas Pier Luigi Temporelli Alexandre Mebazaa Mitja Lainscak Cécile Laroche Aldo Pietro Maggioni Massimo F. Piepoli Andrew J.S. Coats Roberto Ferrari Luigi Tavazzi 《European journal of heart failure》2018,20(1):100-110
16.
Epidemiology and one‐year outcomes in patients with chronic heart failure and preserved,mid‐range and reduced ejection fraction: an analysis of the ESC Heart Failure Long‐Term Registry
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Ovidiu Chioncel Mitja Lainscak Petar M. Seferovic Stefan D. Anker Maria G. Crespo‐Leiro Veli‐Pekka Harjola John Parissis Cecile Laroche Massimo Francesco Piepoli Candida Fonseca Alexandre Mebazaa Lars Lund Giuseppe A. Ambrosio Andrew J. Coats Roberto Ferrari Frank Ruschitzka Aldo P. Maggioni Gerasimos Filippatos 《European journal of heart failure》2017,19(12):1574-1585
17.
Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND‐HF
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Adam D. DeVore Vic Hasselblad Robert J. Mentz Christopher M. O'Connor Paul W. Armstrong John J. McMurray Justin A. Ezekowitz W.H. Wilson Tang Randall C. Starling Adriaan A. Voors Robert M. Califf Adrian F. Hernandez 《European journal of heart failure》2015,17(3):340-346
18.
Jaewon Oh Seok-Min Kang Namki Hong Jong-Chan Youn Seongwoo Han Eun-Seok Jeon Myeong-Chan Cho Jae-Joong Kim Byung-Su Yoo Shung Chull Chae Byung-Hee Oh Dong-Ju Choi Myung-Mook Lee Kyu-Hyung Ryu 《International journal of cardiology》2013
Background
Hemoconcentration is a surrogate marker of effective decongestion and diuresis therapy. Recently, hemoconcentration has been associated with decreased mortality and rehospitalization in heart failure (HF) patients. However, the prognostic power of hemoconcentration in a large sample-sized HF cohort was limited until now.Methods and results
We analyzed data from hospitalized patients with acute heart failure (AHF) that were enrolled in the Korean Heart Failure Registry(n = 2,357). The primary end point was a composite of all-cause mortality and HF rehospitalization during the follow-up period (median = 347, interquartile range = 78–744 days).Hemoconcentration, defined as an increased hemoglobin level between admission and discharge, was presented in 1,016 AHF patients (43.1%). In multivariable logistic regression, hemoglobin, total cholesterol, and serum glucose levels at admission, and ischemic HF, were significant determinants for hemoconcentration occurrence. The Kaplan–Meier curve showed that event-free survival was significantly higher in the hemoconcentration group compared to the non-hemoconcentration group (65.1% vs. 58.1%, log rank p < 0.001). In multiple Cox proportional hazard analysis, hemoconcentration was an independent predictor of the primary end point after adjusting for other HF risk factors (hazard ratio = 0.671, 95% confidence interval = 0.564–0.798, p < 0.001).Conclusions
Hemoconcentration during hospitalization was a prognostic marker of fewer clinical events in the AHF cohort. Therefore, this novel surrogate marker will help in the risk stratification of AHF patients. 相似文献19.
Julio Núñez Pau Llàcer Eduardo Núñez Silvia Ventura Clara Bonanad Vicent Bodí Gema Miñana Enrique Santas Beatriz Mascarell Gregg C. Fonarow Francisco J. Chorro Juan Sanchis 《International journal of cardiology》2014
Background
The use of loop diuretics in acute heart failure (AHF) is largely empirical and has been associated with renal function impairment by reducing renal perfusion but also renal improvement by decreasing renal venous congestion. Antigen carbohydrate 125 (CA125) has emerged as a proxy for fluid overload. We sought to evaluate whether the early changes in creatinine (ΔCr) induced by intravenous furosemide doses (ivFD) differ among clinical groups defined by overload status (CA125) and creatinine on admission (Cr).Methods and results
We included 526 consecutive patients admitted for AHF. All patients received intravenous furosemide for the first 48 hours. CA125 and Cr were dichotomized at 35 U/ml and 1.4 mg/dl, respectively, and grouped as follows: C1 [Cr < 1.4, CA125 ≤ 35 (n = 151)]; C2 [Cr < 1.4, CA125 > 35 (n = 241)]; C3 [Cr ≥ 1.4, CA125 ≤ 35 (n = 45)]; and C4 [Cr ≥ 1.4, CA125 > 35 (n = 89)]. Clinicians in charge of the management of patients were blind to CA125 values. ΔCr was estimated as the absolute difference in Cr between admission and 48–72 hours. Multivariable linear regression analysis was used for modeling purposes. The adjusted analysis showed a differential effect of ivFD on ΔCr. Per increase in 20 mg/day of ivFD, the mean ΔCr was 0.010 mg/dl (p = 0.464) in C1, 0.002 mg/dl (p = 0.831) in C2, 0.045 mg/dl (p = 0.032) in C3, and − 0.045 mg/dl (p < 0.001) in C4 (omnibus p < 0.001). A similar pattern of response was observed in a validation cohort.Conclusions
In patients with AHF, the magnitude and direction of ΔCr attributable to ivFD were differentially associated with values of CA125 and Cr on admission. 相似文献20.
Aldo P. Maggioni Ulf Dahlstrm Gerasimos Filippatos Ovidiu Chioncel Marisa Crespo Leiro Jaroslaw Drozdz Friedrich Fruhwald Lars Gullestad Damien Logeart Gianna Fabbri Renato Urso Marco Metra John Parissis Hans Persson Piotr Ponikowski Mathias Rauchhaus Adriaan A. Voors Olav Wendelboe Nielsen Faiez Zannad Luigi Tavazzi 《European journal of heart failure》2013,15(7):808-817