Assessment of filling pressures and fluid overload in heart failure: an updated perspective

Espriella, Rafael de la; Cobo, Marta; Santas, Enrique; Verbrugge, Frederik H.; Fudim, Marat; Girerd, Nicolas; Miñana, Gema; Górriz, José Luis; Bayés‐Genís, Antoni; Núñez, Julio

doi:10.1016/j.rec.2022.07.009

Cited by 17 publications

(27 citation statements)

References 84 publications

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“…This is of especially importance in those patients with a predominantly tissue congestion phenotype, with little intravascular congestion, characterized by hypochloraemia and haemoconcentration, advocating other strategies based on SGLT2i and tolvaptan, with the aim of minimizing adverse events. Undoubtedly, the assessment of the congestion phenotype must be based on a multiparametric approach, with physical examination, anamnesis, ultrasound, and biomarkers, [27][28][29] with chloride being a new tool, together with haemoconcentration, necessary for this phenotyping.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of plasma chloride in elderly patients hospitalized for acute heart failure

et al. 2023

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Aims Previous studies demonstrated the relationship between hypochloraemia and poor prognosis in patients hospitalized for acute heart failure (AHF). However, the usefulness of chloride in clinical practice remains uncertain, notably in very old patients with predominantly heart failure (HF) with preserved ejection fraction (HFpEF). We aimed to evaluate the prognostic impact of chloride in a cohort of very aged patients with AHF and the possible existence of different phenotypes of hypochloraemia with distinct clinical significance. Methods and resultsIt was an observational study of 429 patients hospitalized for AHF in which chloraemia was measured. Two different phenotypes of hypochloraemia were identified by their relationship with estimated plasma volume status (ePVS) as a proxy of intravascular congestion. The endpoint of interest was time to all-cause mortality and the composite of death and/or HF readmission. A multivariable Cox proportional hazard regression model was constructed to analyse the endpoints. The median age was 85 (78-92) years, 266 (62%) were women, and 80% had HFpEF. After multivariable analysis, chloraemia, but not natraemia, was associated with the risk of death and HF readmission in a U-shaped pattern. The phenotype characterized by hypochloraemia and low ePVS (depletional) was associated with an increased risk of mortality when compared with patients with normochloraemia [hazard ratio (HR) 1.86, P = 0.008]. In contrast, hypochloraemia with high ePVS (dilutional) had no prognostic significance (HR 0.94, P = 0.855). Conclusions In very old patients hospitalized with AHF, plasma chloride was associated with the risk of death and HF readmission in a U-shaped pattern and could potentially be used for congestion phenotyping.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of plasma chloride in elderly patients hospitalized for acute heart failure

et al. 2023

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“…Although distinguishing irreversible forms of kidney dysfunction from likely reversible forms is challenging, a comprehensive and multiparametric evaluation of congestion/hypoperfusion, including point-of-care ultrasound, invasive assessment (i.e. right heart catheterization, invasive blood volume analysers), bioimpedance tools and biomarkers, may provide relevant information regarding which patients are likely to benefit from those therapies [ 32 ]. In this scenario, cardiorenal clinics may offer a window for patient optimization before patient eligibility.…”

Section: Definition and Objectivesmentioning

confidence: 99%

“…Therefore, one of the most important qualification standards for cardiorenal specialists is a deep understanding of cardiorenal physiology (with a particular focus on intrarenal haemodynamics and the complex and dynamic interplay between the interstitial and intravascular fluid compartments) as well as diuretic pharmacokinetics and pharmacodynamics. Accordingly, one standard operating procedure in each clinical visit should be a comprehensive and multiparametric evaluation of volume status to detect subclinical congestion, better phenotype congestion profiles [ 32 ] and offer personalized management [ 40–43 ] strategies.…”

Section: Definition and Objectivesmentioning

confidence: 99%

Practical approaches to building up a cardiorenal clinic

Espriella

Cobo

Ronco

et al. 2022

Clinical Kidney Journal

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The population with concomitant heart and kidney disease (often termed “cardiorenal” disease) is expected to grow, significantly impacting public health and health care utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated, and specialized care would be a positive shift toward improving patient outcomes and optimizing healthcare resources. This document aims to define the organizational aspects and the key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease.

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“…From a theoretical point of view, HF care needs to move forward into precision medicine incorporating new tools into the standard clinical assessment. 2 This is especially true for congestion assessment in which the current perspective stands up to a multiparametric evaluation. 3 According to our findings, BOSI >3% emerges as a highly reproducible parameter positively related to the burden of HF decompensations.…”

Section: Reply To the Letter Regarding The Article 'Bending Oxygen Sa...mentioning

confidence: 99%

Reply to the letter regarding the article ‘Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure

Espriella

Bayés‐Genís

Núñez

2022

European J of Heart Fail

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Assessment of filling pressures and fluid overload in heart failure: an updated perspective

Cited by 17 publications

References 84 publications

Prognostic significance of plasma chloride in elderly patients hospitalized for acute heart failure

Prognostic significance of plasma chloride in elderly patients hospitalized for acute heart failure

Practical approaches to building up a cardiorenal clinic

Reply to the letter regarding the article ‘Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure

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