Role of Response-to-Diuretic in Predicting Prognosis in Discharged Heart Failure Patients After an Acute Decompensation
| Autor: | Sara Ariotti, Marco Cardone, Marzia Testa, Cinzia Ferreri, Mario Sola, Mauro Feola, Gian Luca Rosso |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Galectin 3 Galectins medicine.medical_treatment Renal function Diuresis 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Furosemide Recurrence Internal medicine Natriuretic Peptide Brain medicine Humans Decompensation 030212 general & internal medicine Diuretics Aged Heart Failure business.industry Blood Proteins General Medicine medicine.disease Patient Discharge Hospitalization Transplantation Log-rank test Treatment Outcome Clinical research Echocardiography Heart failure Cardiology Female Diuretic business Biomarkers |
| Zdroj: | Archives of Medical Research. 49:198-204 |
| ISSN: | 0188-4409 |
| Popis: | The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure (ADHF) patients. The objectives of this clinical research, will aim are to: a) include diuresis in the formula for diuretic response (R-to-D); b) add to R-to-D the value of a pre-discharged determination of galectin-3 and BNP in predicting mid-term clinical outcome.Consecutive patients discharged alive after an ADHF were enrolled. All patients underwent BNP and galectin-3, a 6 min walk test and an echocardiogram together with diuresis and body weight during diuretic administration. Death by any cause, cardiac transplantation and worsening HF requiring readmission to the hospital were considered cardiovascular events.141 patients (98 males, age 73.8) were analysed (follow-up 17 months). During the follow-up 45 (31.9%) events were scheduled (19 cardiac deaths, 26 re-hospitalisation for HF). Patients who experienced CV-event had a worst renal function (p = 0.003), an higher BNP (p = 0.006) and galectin-3 (p = 0.008). At multivariate analysis, only R-to-D, galectin-3 and BNP showed a significant correlation with worst clinical prognosis (respectively p = 0.043; OR 6.01; p = 0.01; OR 8.9; p = 0.02 OR 10.38), independently of age and renal function. Kaplan-Meier curves depicted a powerful stratification using an R-to-D1.2 kg/40 mg furosemide (log rank 10.96; p = 0.0009). Adding R-to-D1.2 mg/40 mg furosemide to galectin-317.6 pg/mL and BNP500 pg/mL the predictive value improved (log rank 23.59; p = 0.0001).Adding R-to-D to Gal-3 and BNP, a single pre-discharge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode. |
| Databáze: | OpenAIRE |
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