Approach to decongestion therapy in patients with acute decompensated heart failure: the echocardiography guided strategy

Abstract

Goal The E / (Ea×Sa) index is an echocardiographic parameter to determine a patient’s left ventricular filling pressure. This study aims to determine the safety and efficacy of the echocardiographic E / (Ea×Sa) index guided diuretic therapy compared to urine output (conventional) guided diuretic treatment.Material and Methods In this cross-sectional study, patients with heart failure with reduced ejection fraction (HFrEF) who were hospitalized due to acute decompensation episode were consecutively allocated in a 1:1 ratio to monitoring arms. The diuretic dose, which provided 20 % reduction in the E / (Ea×Sa) index value compared to initial value, was determined as adequate dose in echocardiography guided monitoring group. The estimated glomerular filtration rate (eGFR), change in weight, NT pro-BNP level and dyspnea assessment on visual analogue scale (VAS) were analyzed at the end of the monitoring.Results Although the similar doses of diuretics were used in both groups, the patients with E / (Ea×Sa) index guided strategy had the substantial lower NT pro-BNP level within 72 hours after diuretic administration (2172 vs.2514 pg / mL, p= 0.036). VAS score on dyspnea assessment was significantly better in the patients with E / (Ea×Sa) index guided strategy (52 vs. 65; p= 0.04). And, in term of body weight loss (4.93 vs.5.21 kg, p=0.87) and e-GFR (54.58±8.6 vs. 52.65±9.1 mL / min / 1.73 m2p=0.74) in both groups are associated with similar outcomes. In both groups, there was no worsening renal function and electrolyte imbalance that required stopping or decreasing loop diuretic dosing.Conclusions The E / (Ea×Sa) index guidance might be a safe strategy for more effective diuretic response that deserves consideration for selected a subgroup of acute decomposed HFrEF patients.

Diuretics or ultrafiltration in the treatment of acute decompensated heart failure: An updated systematic review and meta‐analysis

“…The endpoint studied in this study was the change in serum creatinine levels as a marker of kidney injury; however, there was a huge difference in baseline kidney function among the two groups (serum creatinine levels were 3.25 in the UF group vs. 1.75 in the diuretics group), and therefore the initial categorization of patients among groups seemed problematic. Another study [39] which was identified in our first search of literature and was translated from Russian but was not included as well because of issues in randomization process. Although it was described as a randomized control trial, there was no clear description of the process.…”

“…For the outcome of weight change, four studies were excluded from our analysis. Two of these studies [28, 38] had fewer than 10 patients in each arm and the other two [37, 39] compared practically different populations as we described in detail above. In disagreement with our finding, in this review, the weight change was calculated as an absolute, positive number in three of these studies which resulted in a weight change in favor of diuretics.…”