AIMS: Recent observations in chronic stable heart failure suggest that high-dose loop diuretics (HDLDs) have detrimental prognostic effects in patients with high blood urea nitrogen (BUN), but recent findings have also indicated that diuretics may improve renal function. Carbohydrate antigen 125 (CA125) has been shown to be a surrogate of systemic congestion. We sought to explore whether BUN and CA125 modulate the mortality risk associated with HDLDs following a hospitalization for acute heart failure (AHF). METHODS AND RESULTS: We analysed 1389 consecutive patients discharged for AHF. CA125 and BUN were measured at a mean of 72 ± 12 h after admission. HDLDs (≥120 mg/day in furosemide equivalent dose) were interacted to a four-level variable according to CA125 (>35 U/mL) and BUN (above the median), and related to all-cause mortality. At a median follow-up of 21 months, 561 (40.4%) patients died. The use of HDLDs was independently associated with increased mortality [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.01-1.50], but this association was not homogeneous across CA125-BUN categories (P for interaction <0.001). In patients with normal CA125, use of HDLDs was associated with high mortality if BUN was above the median (HR 2.29, 95% 1.51-3.46), but not in those with BUN below the median (HR 1.22, 95% CI 0.73-2.04). Conversely, in patients with high CA125, HDLDs showed an association with increased survival if BUN was above the median (HR 0.73, 95% CI 0.55-0.98) but was associated with increased mortality in those with BUN below the median (HR 1.94, 95% CI 1.36-2.76). CONCLUSION: The risk associated with HDLDs in patients after hospitalization for AHF was dependent on the levels of BUN and CA125. The information provided by these two biomarkers may be helpful in tailoring the dose of loop diuretics at discharge for AHF.
AIMS: Recent observations in chronic stable heart failure suggest that high-dose loop diuretics (HDLDs) have detrimental prognostic effects in patients with high blood ureanitrogen (BUN), but recent findings have also indicated that diuretics may improve renal function. Carbohydrate antigen 125 (CA125) has been shown to be a surrogate of systemic congestion. We sought to explore whether BUN and CA125 modulate the mortality risk associated with HDLDs following a hospitalization for acute heart failure (AHF). METHODS AND RESULTS: We analysed 1389 consecutive patients discharged for AHF. CA125 and BUN were measured at a mean of 72 ± 12 h after admission. HDLDs (≥120 mg/day in furosemide equivalent dose) were interacted to a four-level variable according to CA125 (>35 U/mL) and BUN (above the median), and related to all-cause mortality. At a median follow-up of 21 months, 561 (40.4%) patients died. The use of HDLDs was independently associated with increased mortality [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.01-1.50], but this association was not homogeneous across CA125-BUN categories (P for interaction <0.001). In patients with normal CA125, use of HDLDs was associated with high mortality if BUN was above the median (HR 2.29, 95% 1.51-3.46), but not in those with BUN below the median (HR 1.22, 95% CI 0.73-2.04). Conversely, in patients with high CA125, HDLDs showed an association with increased survival if BUN was above the median (HR 0.73, 95% CI 0.55-0.98) but was associated with increased mortality in those with BUN below the median (HR 1.94, 95% CI 1.36-2.76). CONCLUSION: The risk associated with HDLDs in patients after hospitalization for AHF was dependent on the levels of BUN and CA125. The information provided by these two biomarkers may be helpful in tailoring the dose of loop diuretics at discharge for AHF.
Authors: Markku S Nieminen; Michael Böhm; Martin R Cowie; Helmut Drexler; Gerasimos S Filippatos; Guillaume Jondeau; Yonathan Hasin; José Lopez-Sendon; Alexandre Mebazaa; Marco Metra; Andrew Rhodes; Karl Swedberg; Silvia G Priori; Maria Angeles Alonso Garcia; Jean-Jacques Blanc; Andrzej Budaj; Martin R Cowie; Veronica Dean; Jaap Deckers; Enrique Fernandez Burgos; John Lekakis; Bertil Lindahl; Gianfranco Mazzotta; João Morais; Ali Oto; Otto A Smiseth; Maria Angeles Alonso Garcia; Kenneth Dickstein; Anibal Albuquerque; Pedro Conthe; Maria Crespo-Leiro; Roberto Ferrari; Ferenc Follath; Antonello Gavazzi; Uwe Janssens; Michel Komajda; João Morais; Rui Moreno; Mervyn Singer; Satish Singh; Michal Tendera; Kristian Thygesen Journal: Eur Heart J Date: 2005-01-28 Impact factor: 29.983
Authors: Ali Ahmed; Ahsan Husain; Thomas E Love; Giovanni Gambassi; Louis J Dell'Italia; Gary S Francis; Mihai Gheorghiade; Richard M Allman; Sreelatha Meleth; Robert C Bourge Journal: Eur Heart J Date: 2006-05-18 Impact factor: 29.983
Authors: Wayne C Levy; Dariush Mozaffarian; David T Linker; Santosh C Sutradhar; Stefan D Anker; Anne B Cropp; Inder Anand; Aldo Maggioni; Paul Burton; Mark D Sullivan; Bertram Pitt; Philip A Poole-Wilson; Douglas L Mann; Milton Packer Journal: Circulation Date: 2006-03-13 Impact factor: 29.690
Authors: Michael Domanski; James Norman; Bertram Pitt; Mark Haigney; Stephen Hanlon; Eliot Peyster Journal: J Am Coll Cardiol Date: 2003-08-20 Impact factor: 24.094
Authors: João Pedro Ferreira; Nicolas Girerd; Pedro Bettencourt Medeiros; Miguel Bento Ricardo; Tiago Almeida; Alexandre Rola; Faiez Zannad; Patrick Rossignol; Irene Aragão Journal: Cardiorenal Med Date: 2017-01-21 Impact factor: 2.041
Authors: Jeffrey M Testani; Meredith A Brisco; Jeffrey M Turner; Erica S Spatz; Lavanya Bellumkonda; Chirag R Parikh; W H Wilson Tang Journal: Circ Heart Fail Date: 2013-12-30 Impact factor: 8.790
Authors: Julio Núñez; Gabriel A Rabinovich; Justo Sandino; Luis Mainar; Patricia Palau; Enrique Santas; Maria Pilar Villanueva; Eduardo Núñez; Vicent Bodí; Francisco J Chorro; Gema Miñana; Juan Sanchis Journal: PLoS One Date: 2015-04-13 Impact factor: 3.240