Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation

被引：14

作者：

Baudry, Guillaume ^{[1
]}

Coutance, Guillaume ^{[2
]}

Dorent, Richard ^{[3
]}

Bauer, Fabrice ^{[4
]}

Blanchart, Katrien ^{[5
]}

Boignard, Aude ^{[6
]}

Chabanne, Celine ^{[7
]}

Delmas, Clement ^{[8
]}

D'Ostrevy, Nicolas ^{[9
]}

Epailly, Eric ^{[10
]}

Gariboldi, Vlad ^{[11
]}

Gaudard, Philippe ^{[12
]}

Goeminne, Celine ^{[13
]}

Grosjean, Sandrine ^{[14
]}

Guihaire, Julien ^{[15
]}

Guillemain, Romain ^{[16
]}

Mattei, Mathieu ^{[17
]}

Nubret, Karine ^{[18
]}

Pattier, Sabine ^{[19
]}

Vermes, Emmanuelle ^{[20
]}

Sebbag, Laurent ^{[21
]}

Duarte, Kevin ^{[1
]}

Girerd, Nicolas ^{[1
]}

机构：

[1] Univ Lorraine, CHRU Nancy, Reicatra, F CRIN INI CRCT,Ctr Invest Clin Plurithemat 1433,I, F-54500 Vandoeuvre Les Nancy, France

[2] Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Cardiac & Thorac Surg,Cardiol Inst,Med Sch, Paris, France

[3] Univ Paris VII, Dept Cardiac Surg, CHU Bichat Claude Bernard, AP HP, Paris, France

[4] Hop Charles Nicolle, Dept Cardiol & Cardiovasc Surg, Rouen, France

[5] Univ Caen, Univ Hosp Caen, Dept Cardiol & Cardiac Surg, Caen, France

[6] CHU Michallon, Dept Cardiol & Cardiovasc Surg, Grenoble, France

[7] CHU Pontchaillou, Dept Thorac & Cardiovasc Surg, INSERM, U1099, Rennes, France

[8] Ctr Hosp Univ Toulouse, Dept Cardiol, Toulouse, France

[9] CHU Clermont Ferrand, Dept Cardiol & Cardiac Surg, Clermont Ferrand, France

[10] Hop Univ Strasbourg, Dept Cardiol & Cardiovasc Surg, Strasbourg, France

[11] La Timone Hosp, Dept Cardiac Surg, Marseille, France

[12] CHRU Montpellier, Arnaud Villeneuve Hosp, Dept Cardiac Surg Anesthesiol & Crit Care Med, Montpellier, France

[13] CHU Lille, Inst Coeur Poumons, Dept Cardiac Surg, Lille, France

[14] Dijon Univ Hosp, Dept Cardiol & Cardiac Surg, Dijon, France

[15] Univ Paris Sud, Dept Cardiothorac Surg, Marie Lannelongue Hosp, INSERM,U999 Pulm Hypertens Pathophysiol & Novel Th, Le Plessis Robinson, France

[16] Hop Europeen Georges Pompidou, Dept Cardiol & Cardiac Surg, Paris, France

[17] CHU Nancy, Hop Brabois, Dept Cardiol & Cardiac Surg, Nancy, France

[18] Univ Bordeaux II, Hop Cardiol Haut Leveque, Dept Thorac & Cardiovasc Surg, Bordeaux, France

[19] CHU Nantes, Dept Cardiol & Heart Transplantat Unit, Nantes, France

[20] Tours Univ Hosp, Dept Cardiothorac Surg, Tours, France

[21] Hosp Civils Lyon, Hop Cardiovasc Louis Pradel, Dept Heart Failure & Transplantat, Bron, France

来源：

ESC HEART FAILURE | 2023年 / 10卷 / 05期

关键词：

Advanced heart failure; Diuretic; Heart transplant; Congestion; Cardiorenal syndrome; TRIMETHYLAMINE N-OXIDE; LOOP DIURETICS; RENAL-FUNCTION; FAILURE; MORTALITY; HOSPITALIZATION; CONGESTION; SURVIVAL; DYSFUNCTION; PREDICTION;

D O I：

10.1002/ehf2.14467

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

AimsThe prognostic value of 'high dose' loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and resultsAll ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into 'low dose', 'intermediate dose', and 'high dose' loop diuretics corresponding to furosemide equivalent doses of & LE;40, 40-250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N-terminal pro-B-type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for 'low dose', 'intermediate dose', and 'high dose' patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the 'high dose' group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six-fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the 'low dose' group. 'Intermediate doses' were not significantly associated with these two outcomes in adjusted models (P > 0.05). ConclusionsA 'high dose' of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre-HT patients.

引用

页码：2843 / 2852

页数：10

共 33 条

[1] Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial [J].