Phenotype and outcomes according to loop diuretic use in pulmonary arterial hypertension.

Autor: Savonitto G; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy., Barbisan D; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy., Ameri P; Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.; Department of Internal Medicine, University of Genova, Genoa, Italy., Lombardi CM; Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Monti S; Cardiology and Pneumology Division, Fondazione Monasterio, Pisa, Italy.; Institute of Clinical Physiology (IFC)-CNR, Pisa, Italy., Driussi M; Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy., Gentile P; De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy., Howard L; Imperial College London, Faculty of Medicine, National Heart & Lung Institute, London, UK.; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK., Toma M; Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.; Department of Internal Medicine, University of Genova, Genoa, Italy., Pagnesi M; Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Collini V; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy.; Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy., Bauleo C; Cardiology and Pneumology Division, Fondazione Monasterio, Pisa, Italy., Adamo M; Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., D'Angelo L; De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy., Nalli C; Cardiac Surgery, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy., Giannoni A; Cardiology and Pneumology Division, Fondazione Monasterio, Pisa, Italy.; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna (SSSA), Pisa, Italy., Vecchiato V; Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.; Department of Internal Medicine, University of Genova, Genoa, Italy., Di Poi E; Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy., Airo E; Cardiology and Pneumology Division, Fondazione Monasterio, Pisa, Italy., Metra M; Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Garascia A; De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy., Sinagra G; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy., Lo Giudice F; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK., Stolfo D; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy.; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2024 Oct; Vol. 11 (5), pp. 3146-3154. Date of Electronic Publication: 2024 Jun 13.
DOI: 10.1002/ehf2.14818
Abstrakt: Aims: The use of loop diuretics in pulmonary arterial hypertension (PAH) is less frequent compared with heart failure. The clinical and prognostic characteristics of PAH patients according to loop diuretic use remain unexplored. In this study, we retrospectively analysed the characteristics and survival of PAH patients requiring different doses of loop diuretics.
Methods and Results: Patients diagnosed with PAH between 2001 and 2022 at seven European centres for the management of PAH. According to the median equivalent dose of furosemide in the overall cohort, patients were divided into two subgroups: no/low-dose loop diuretic and high-dose loop diuretic. Primary outcome was 5 year all-cause mortality. Among the 397 patients included, 227 (57%) were treated with loop diuretics. Median daily furosemide equivalent dose was 25 mg, and accordingly patients were divided in no/low dose (i.e. ≤25 mg, n = 257, 65%) vs. high dose (i.e. >25 mg, n = 140, 35%). Patients in the high-dose group were older, more likely to have comorbidities, and had a more severe disease according to the ESC/ERS risk category. Crude 5 year survival was significantly shorter in patients in the high-dose group, but after adjustment for age, sex, and risk category, high loop diuretic dose was not significantly associated with the primary outcome.
Conclusions: Use of high dose of loop diuretics in PAH is associated with a higher burden of comorbidities, more severe disease, and worse survival. However, in PAH, the need of high loop diuretic dose is a marker of disease severity and not an independent prognostic factor.
(© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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