BACKGROUND: Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. METHODS AND RESULTS: For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72-96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro-B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs -0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). CONCLUSIONS: In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.
BACKGROUND: Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. METHODS AND RESULTS: For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72-96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro-B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs -0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). CONCLUSIONS: In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.
Authors: Anuradha Lala; Steven E McNulty; Robert J Mentz; Shannon M Dunlay; Justin M Vader; Omar F AbouEzzeddine; Adam D DeVore; Prateeti Khazanie; Margaret M Redfield; Steven R Goldsmith; Bradley A Bart; Kevin J Anstrom; G Michael Felker; Adrian F Hernandez; Lynne W Stevenson Journal: Circ Heart Fail Date: 2015-06-03 Impact factor: 8.790
Authors: Bradley A Bart; Steven R Goldsmith; Kerry L Lee; Margaret M Redfield; G Michael Felker; Christopher M O'Connor; Horng H Chen; Jean L Rouleau; Michael M Givertz; Marc J Semigran; Douglas Mann; Anita Deswal; David A Bull; Martin M Lewinter; Eugene Braunwald Journal: J Card Fail Date: 2012-02-02 Impact factor: 5.712
Authors: Andrew P Ambrosy; Peter S Pang; Sadiya Khan; Marvin A Konstam; Gregg C Fonarow; Brian Traver; Aldo P Maggioni; Thomas Cook; Karl Swedberg; John C Burnett; Liliana Grinfeld; James E Udelson; Faiez Zannad; Mihai Gheorghiade Journal: Eur Heart J Date: 2013-01-04 Impact factor: 29.983
Authors: G Michael Felker; Kerry L Lee; David A Bull; Margaret M Redfield; Lynne W Stevenson; Steven R Goldsmith; Martin M LeWinter; Anita Deswal; Jean L Rouleau; Elizabeth O Ofili; Kevin J Anstrom; Adrian F Hernandez; Steven E McNulty; Eric J Velazquez; Abdallah G Kfoury; Horng H Chen; Michael M Givertz; Marc J Semigran; Bradley A Bart; Alice M Mascette; Eugene Braunwald; Christopher M O'Connor Journal: N Engl J Med Date: 2011-03-03 Impact factor: 91.245
Authors: Horng H Chen; Omar F AbouEzzeddine; Kevin J Anstrom; Michael M Givertz; Bradley A Bart; G Michael Felker; Adrian F Hernandez; Kerry L Lee; Eugene Braunwald; Margaret M Redfield Journal: Circ Heart Fail Date: 2013-09-01 Impact factor: 8.790
Authors: Bradley A Bart; Steven R Goldsmith; Kerry L Lee; Michael M Givertz; Christopher M O'Connor; David A Bull; Margaret M Redfield; Anita Deswal; Jean L Rouleau; Martin M LeWinter; Elizabeth O Ofili; Lynne W Stevenson; Marc J Semigran; G Michael Felker; Horng H Chen; Adrian F Hernandez; Kevin J Anstrom; Steven E McNulty; Eric J Velazquez; Jenny C Ibarra; Alice M Mascette; Eugene Braunwald Journal: N Engl J Med Date: 2012-11-06 Impact factor: 91.245
Authors: Horng H Chen; Kevin J Anstrom; Michael M Givertz; Lynne W Stevenson; Marc J Semigran; Steven R Goldsmith; Bradley A Bart; David A Bull; Josef Stehlik; Martin M LeWinter; Marvin A Konstam; Gordon S Huggins; Jean L Rouleau; Eileen O'Meara; W H Wilson Tang; Randall C Starling; Javed Butler; Anita Deswal; G Michael Felker; Christopher M O'Connor; Raphael E Bonita; Kenneth B Margulies; Thomas P Cappola; Elizabeth O Ofili; Douglas L Mann; Víctor G Dávila-Román; Steven E McNulty; Barry A Borlaug; Eric J Velazquez; Kerry L Lee; Monica R Shah; Adrian F Hernandez; Eugene Braunwald; Margaret M Redfield Journal: JAMA Date: 2013-12-18 Impact factor: 56.272