Integral assessment of congestion in patients with acute decompensated heart failure

Aim. To study the efficacy and safety of acetazolamide administered orally to patients with decompensated heart failure (HF) at the hospital stage within 72 hours from admission, compared with standard therapy.Material and methods. This open-label, prospective, randomized, multicenter study is planned to include 400 patients urgently admitted to hospital with NYHA class II-IV decompensated HF: 200 patients each in the standard therapy group and additional acetazolamide (tablets) group. The primary endpoint includes the number of patients who achieved compensation in accordance with the criteria for diuretic therapy discontinuation. There are secondary endpoints: increase in urine output in the first 72 hours of hospitalization (since randomization), weight loss, 24-hour natriuresis, length of stay in hospital, length of stay in the intensive care unit, 90-day any-cause death, 90-day cardiovascular death, 90-day death due to chronic HF decompensation or acute decompensated HF, the number of pleuro- and pericardiocentesis episodes during the hospitalization, scale for clinical condition assessment of HF patient (SHOKS) at discharge from the hospital, 6-minute walk test at discharge from the hospital. The planned follow-up duration is a hospital period with an assessment of the clinical picture and laboratory parameters. Telemedicine contact with patients is carried out after 14, 30 and 90 days using a structured questionnaire.Conclusion. Analysis of clinical, laboratory and echocardiographic parameters of patients using acetazolamide tablets will make it possible to determine the criteria for the effectiveness of diuretic therapy in patients with decompensated HF in the short and long term.

Efficacy and safety of acetazolamide in patients with NYHA class II-IV decompensated heart failure: protocol of an open-label prospective randomized multicenter study (ORION-A)

Rubanenko,

Villevalde

et al. 2023

Decompensated heart failure: a reconceptualization in the light of updated consensus statement of the European Society of Cardiology

Larina,

Kokorin,

Larin

et al. 2023

The article presents a brief analytical review of the European Society of Cardiology consensus statement on the definition and clinical features of heart failure (HF) with a summary of the latest results on the treatment and prevention of exacerbation. The main viewpoints are compared with existing approaches in the Russian Federation. The definition and classification of worsening HF (WHF), as well as its main clinical manifestations, epidemiology, outcomes, pathophysiology, approaches to early detection, patterns of in- and outpatient treatment of WHF are discussed. Attention is paid to the terminology necessary to identify a cohort of patients with HF exacerbation with a previously established diagnosis of HF in order to unify approaches to diagnosis and treatment.

Albuminuria as a marker of systemic congestion and a predictor of poor long-term prognosis in acute decompensated heart failure

Kobalava,

Kontareva,

Khruleva

et al. 2024

Self Cite

Aim. To identify the relationship of different albuminuria levels with paraclinical signs of congestion on admission and discharge and with the prognosis of acute decompensated heart failure (ADHF).Material and methods. Patients hospitalized with ADHF were included. Albuminuria level was assessed on admission and discharge. Patients were divided into groups according to albuminuria level (A1, A2, A3) according to KDIGO guidelines. Among the congestion parameters, the following were assessed: N-terminal pro-brain natriuretic peptide (NT-proBNP), lung ultrasound examination (BLUE protocol), venous congestion according to the VExUS ultrasound protocol (inferior vena cava, portal, hepatic and renal veins). The primary endpoint was a composite of all-cause death and rehospitalization for ADHF within 180 days of discharge.Results. The final analysis included 180 patients. The prevalence of A1, A2 and A3 albuminuria at admission was 50%, 39%, 11%, respectively. A greater degree of albuminuria was associated with worse renal function at admission and discharge. Patients with increased albuminuria on admission had higher NT-proBNP and a greater number of B-lines on pulmonary ultrasound in on admission and discharge, and a higher degree of complex venous congestion and renal vein congestion on VExUS on admission. A3 albuminuria at admission and discharge was associated with an increased risk of poor long-term prognosis (hazard ratio (HR) 3,551; 95% confidence interval (CI) 1,593-7,914; p=0,002), (HR 4,362; 95% CI 1,623-11,726; p=0,004).Conclusion. In patients with ADHF, the albuminuria level on admission is associated with the severity of congestion upon admission and discharge. A3 albuminuria at admission and at discharge is a predictor of long-term poor prognosis within 180 days after discharge.