The Effects of Burst Steroid Therapy on Short-term Decongestion in Acute Heart Failure Patients With Pro-inflammatory Activation: A Post Hoc Analysis of the CORTAHF Randomized, Open-label, Pilot Trial.

Autor: Biegus J; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland., Cotter G; Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Heart Initiative, Durham, NC, USA; Momentum Research Inc, Durham, NC, USA., Davison BA; Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Heart Initiative, Durham, NC, USA; Momentum Research Inc, Durham, NC, USA., Freund Y; Sorbonne Université, IMProving Emergency Care FHU, Paris, France; Emergency Department and Service Mobile d'Urgence et de Réanimation (SMUR), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France., Voors AA; University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands., Edwards C; Momentum Research Inc, Durham, NC, USA., Novosadova M; Momentum Research Inc, Durham, NC, USA., Takagi K; Momentum Research Inc, Durham, NC, USA., Hayrapetyan H; Erebouni Medical Center, Yerevan, Armenia., Mshetsyan A; Mikaelyan Surgery Institute CJSC, Yerevan, Armenia., Mayranush D; Armenia Medical Center, Yerevan, Armenia., Cohen-Solal A; Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Department of Cardiology, APHP Nord, Lariboisière University Hospital, Paris, France., ter Maaten JM; University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands., Filippatos G; National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece., Chioncel O; Emergency Institute for Cardiovascular Diseases Prof. C.C.Iliescu University of Medicine Carol Davila, Bucharest, Romania., Sadoune M; Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France., Pagnesi M; Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Simon T; Sorbonne Université, IMProving Emergency Care FHU, Paris, France., Metra M; Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), St Antoine Hospital, APHP, Paris, France., Mann DL; Cardiovascular Division, Department of Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO, USA., Mebazaa A; Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France; Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP Nord, Paris, France., Ponikowski P; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland. Electronic address: piotr.ponikowski@umw.edu.pl.
Jazyk: angličtina
Zdroj: Journal of cardiac failure [J Card Fail] 2024 Sep 29. Date of Electronic Publication: 2024 Sep 29.
DOI: 10.1016/j.cardfail.2024.09.002
Abstrakt: Background: The effect of steroids on congestion in patients with acute heart failure (AHF) is not known.
Methods and Results: Patients with AHF, NT-proBNP levels > 1500 pg/mL and high-sensitivity C-reactive protein (hsCRP) levels > 20 mg/L were randomized to once-daily oral 40 mg prednisone for 7 days or usual care. In this post hoc analysis, congestion score was calculated on the basis of orthopnea, edema and rales (0 reflecting lack of congestion, and 9 maximal congestion) at each time point. Among 100 eligible patients randomized, those assigned to prednisone had a greater improvement in congestion score at day 31 (win odds for the prednisone group compared to usual care at day 31 was 1.77 (95% CI 1.17-2.84; P = 0.0066) in all patients and 2.41 (95% CI 1.37-5.05; P = 0.0016) in patients with IL-6 > 13 pg/mL at baseline. In patients with congestion scores ≥ 7 at baseline, the effects of prednisone therapy on the EQ-5D visual analog scale score were 4.30 (95% CI 0.77-7.83) points at day 7 and 5.40 (0.51-10.29) points at day 31, accompanied by lower heart rate and respiratory rate and higher oxygen saturation compared to usual care.
Conclusions: In patients with AHF and inflammatory activation, 7-day steroid therapy was associated with reduction in signs of congestion up to day 31. These results need confirmation in larger studies examining potential effects of steroids on congestion, diuresis, fluid redistribution and vascular permeability as well as clinical effects in AHF.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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