TY - JOUR
T1 - Relation of Decongestion and Time to Diuretics to Biomarker Changes and Outcomes in Acute Heart Failure
AU - Horiuchi, Yu
AU - Wettersten, Nicholas
AU - van Veldhuisen, Dirk J.
AU - Mueeller, Christian
AU - Filippatos, Gerasimos
AU - Nowak, Richard
AU - Hogan, Christopher
AU - Kontos, Michael C.
AU - Cannon, Chad M.
AU - Mueller, Gerhard A.
AU - Birkhahn, Robert
AU - Taub, Pam
AU - Vilke, Gary M.
AU - Barnett, Olga
AU - McDonald, Kenneth
AU - Mahon, Niall
AU - Nunez, Julio
AU - Briguori, Carlo
AU - Passino, Claudio
AU - Maisel, Alan
AU - Murray, Patrick T.
PY - 2021/5/15
Y1 - 2021/5/15
N2 - Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase-associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease >= 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase-associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis. (C) 2021 The Authors. Published by Elsevier Inc.
AB - Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase-associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease >= 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase-associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis. (C) 2021 The Authors. Published by Elsevier Inc.
KW - GELATINASE-ASSOCIATED LIPOCALIN
KW - NATRIURETIC PEPTIDE LEVELS
KW - ACUTE KIDNEY INJURY
KW - RISK MODEL
KW - FUROSEMIDE
KW - MORTALITY
KW - DISCHARGE
KW - HOSPITALIZATION
KW - SERELAXIN
KW - PRESSURE
U2 - 10.1016/j.amjcard.2021.01.040
DO - 10.1016/j.amjcard.2021.01.040
M3 - Article
SN - 0002-9149
VL - 147
SP - 70
EP - 79
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -