Journal Article Usefulness of the Combination of In-Hospital Poor Diuretic Response and Systemic Congestion to Predict Future Cardiac Events in Patients With Acute Decompensated Heart Failure

Soichiro, Aoki  ,  Takahiro, Okumura  ,  Akinori, Sawamura  ,  Katsuhide, Kitagawa  ,  Ryota, Morimoto  ,  Masaki, Sakakibara  ,  Toyoaki, Murohara

119 ( 12 )  , pp.2010 - 2016 , 2017-06-15 , Elsevier
We aimed to (1) investigate the relation between diuretic response (DR) with or withoutsystemic congestion and prognosis and (2) explore the potential predictors of poor DR forrisk stratification in patients with acute decompensated heart failure (ADHF). We enrolled186 consecutive patients hospitalized for ADHF. The DR was defined as (body weight atdischarge L body weight at admission)/40 mg furosemide or equivalent loop diuretic dose.Systemic congestion on admission was simply evaluated by the presence of leg edema orjugular venous distention. All patients were divided into 4 groups based on the median ofDR (-0.50 kg/40 mg) and the status of systemic congestion; GR/C (good DR with systemiccongestion, n = 66), GR/N (good DR without systemic congestion, n = 27), PR/C (poorDR with systemic congestion, n = 48); and PR/N (poor DR without systemic congestion,n = 45). The composite outcome was defined as cardiac death and rehospitalization forworsening heart failure. In survival analysis, the cardiac event-free rate in PR/C wassignificantly lower than that in any other groups (log-rank, p <0.001), and PR/C was anindependent predictor of cardiac events (hazard ratio 2.17, p = 0.016). In conclusion, thecombination of in-hospital poor DR, characterized by previous ischemic heart disease, andprehospital dose of daily loop diuretics, and systemic congestion provides a risk stratificationfor future cardiac events in patients with ADHF.

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