Nocturia in males with heart failure: Prostatic edema and circadian neurohormonal rhythm

Siniorakis, Eftychios; Kotsanis, Athanassios; Kanderakis, S.P.; Exarchos, S.T.; Kapiris, Ioannis

doi:10.1016/j.ijcard.2006.11.189

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…21,22 In addition, nocturia is well known to accompany volume overload states that occur in the setting of congestive heart failure and poorly controlled hypertension. 4,23 The relation between volume overload and nocturia has been supported by recent studies showing salutary effects of both sodium restriction and loop diuretics on the frequency and severity of nocturia. 24,25 LAE often accompanies volume overload states and is a marker of left ventricular end diastolic pressure along with LVH.…”

Section: Discussionmentioning

confidence: 96%

“…Also, nocturia has been found to be associated with subclinical markers of vascular disease such as endothelial dysfunction and increased arterial stiffness, 20 which, in turn, are often associated with cardiac structural abnormalities 21,22 . In addition, nocturia is well known to accompany volume overload states that occur in the setting of congestive heart failure and poorly controlled hypertension 4,23 . The relation between volume overload and nocturia has been supported by recent studies showing salutary effects of both sodium restriction and loop diuretics on the frequency and severity of nocturia 24,25 .…”

Section: Discussionmentioning

confidence: 97%

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Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

Mekki

Monaghan

Lee

et al. 2020

Neurourology and Urodynamics

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Aims: Nocturia has been increasingly recognized as a potential manifestation of cardiovascular disease. However, the relationship between nocturia and electrocardiographic (ECG) abnormalities has not been studied. This study aims to characterize the diagnostic utility of nocturia in identifying left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc on ECG. Methods: Retrospective analysis of nocturnal voiding frequency and contemporaneous ECG data from consecutive patients evaluated at a university-based outpatient cardiology clinic. Three sets of three incremental binary multiple logistic regression models controlling for (1) age, (2) sex and race, and (3) body mass index, hypertension, diabetes mellitus, and diuretic utilization were performed to determine whether nocturia was predictive of LVH, LAE, and prolonged QTc. Results: Included patients (n = 143, 77.6% nocturia) were predominantly African-American (89.5%), female (74.1%), and obese (61.5%), of whom 44.1%, 41.3%, and 27.3% had LVH, LAE, and prolonged QTc, respectively. Older age, African-American race, obesity, hypertension, diuretic use, LVH, and LAE were significantly associated with nocturia on univariate analysis. No significant differences were observed in the strength of associations between nocturia and LVH, LAE, or QTc prolongation based on age. Nocturia independently predicted LVH in Models I-III (odds ratios [ORs], 2.99-3.20; relative risks [RRs], 1.18 for all, p ≤ .046) and LAE in Models I-III (ORs, 4.24-4.72; RRs, 1.21 for all, p ≤ .015). No significant associations were observed between nocturia and prolonged QTc. Conclusions: Nocturia may be a risk marker for underlying structural cardiac abnormalities.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

Mekki

Monaghan

Lee

et al. 2020

Neurourology and Urodynamics

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“…49,68 For example, in one sample of patients hospitalized for decompensated heart failure, severe nocturia before admission was associated with significantly greater baseline edema severity and serum brain natriuretic peptide concentration, as well as greater absolute improvement in these parameters following standard volume management with diuretics. 69 Similarly, in an outpatient cardiology clinic, improvement in nocturia severity has also been identified as a potential early marker of response to diuretic therapy in the treatment of heart failure. 70 As it relates to clinical practice in the initial evaluation of nocturia, investigation of potential contributory comorbidities requires comprehensive medical history including a detailed review of systems, physical exam not limited to the genitourinary tract, and low threshold for primary care referral for further disease optimization, with potential subsequent medical specialty referral if the appropriate indications are met.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…As a potential harbinger of undiagnosed medical disease, consideration of systems beyond the urinary tract in the evaluation of nocturia has important implications for the patient's overall health and preventative medicine, 67 but also directly relates to the primary treatment of nocturia 49,68 . For example, in one sample of patients hospitalized for decompensated heart failure, severe nocturia before admission was associated with significantly greater baseline edema severity and serum brain natriuretic peptide concentration, as well as greater absolute improvement in these parameters following standard volume management with diuretics 69 . Similarly, in an outpatient cardiology clinic, improvement in nocturia severity has also been identified as a potential early marker of response to diuretic therapy in the treatment of heart failure 70 …”

Section: Introductionmentioning

confidence: 99%

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Monaghan

Weiss

Wein

et al. 2023

Neurourology and Urodynamics

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Introduction Nocturia arises from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture, which may be driven by abnormalities of the genitourinary tract, but also by sleep disorders, medical diseases, patient actions/lifestyle factors, or medications. This article introduces a novel system for organizing the complex differential diagnosis for nocturia, as proposed by an international collective of practicing urologists, physician specialists, and sleep experts: “Sleep CALM”—Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications. Methods Narrative review of current evidence regarding the relevance of each “Sleep CALM” factor to nocturia pathogenesis, evaluation, and management. Results Nocturia and sleep disorders are highly intertwined and often bidirectional, such that nocturnal awakenings for reasons other than a sensation of bladder fullness should not be used as grounds for exclusion from nocturia treatment, but rather leveraged to broaden therapeutic options for nocturia. Nocturia is an important potential harbinger of several serious medical conditions beyond the genitourinary tract. Urologists should have a low threshold for primary care and medical specialty referral for medical optimization, which carries the potential to significantly improve nocturnal voiding frequency in addition to overall health status. Adverse patient actions/lifestyle factors, lower urinary tract dysfunction, and medication use commonly coexist with disordered sleep and comorbid medical conditions, and may be the primary mediators of nocturia severity and treatment response, or further exacerbate nocturia severity and complicate treatment. Conclusion “Sleep CALM” provides a memorable and clinically relevant means by which to structure the initial patient history, physical exam, and clinical testing in accordance with current best‐practice guidelines for nocturia. Although not intended as an all‐encompassing diagnostic tool, the “Sleep CALM” schema may also be useful in guiding individualized ancillary testing, identifying the need for specialty referral and multidisciplinary care, and uncovering first‐line treatment targets.

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“…Peripheral oedemas are redistributed in the supine position, increasing the renal glomerular flow. In addition, in males, prostatic gland oedema secondary to heart failure contributes to nocturia and is relieved after increasing the dose of diuretics especially in the afternoon 3…”

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confidence: 99%

Quantifying the amount of congestion in heart failure

Siniorakis¹,

Arvantakis²,

Marinakis³

et al. 2010

European J of Heart Fail

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We read with great interest the scientific statement concerning the assessment of congestion in heart failure, 1 in which clinical, laboratory, radiographic, dynamic, and echocardiographic indices were evaluated. Here, some additional markers of congestion are proposed. Nocturia is a common manifestation with considerable diagnostic accuracy in congested patients with heart failure. 2Peripheral oedemas are redistributed in the supine position, increasing the renal glomerular flow. In addition, in males, prostatic gland oedema secondary to heart failure contributes to nocturia and is relieved after increasing the dose of diuretics especially in the afternoon. Pleural transudates are frequent in heart failure with pulmonary congestion. These effusions are due to interstitial pulmonary fluids, which escape through the visceral pleura, preventing the development of alveolar oedema. 4 Large pleural transudates can be detected by radiography and echocardiography. The latter is superior as it can estimate the haemodynamic consequences of raised intrapleural pressures into a normal pericardial space. 5When compressive physiology is detected, diuretics are ineffective, and large volume thoracentesis is mandatory. Reappearance of transudates after a few days is an ominous sign of persisting pulmonary congestion.Echocardiographic grading of pulmonary congestion can be completed by simple manoeuvres which modify the left ventricular preload. It is known that the E/E a ratio (E ¼ early diastolic Doppler transmitral velocity and E a ¼ early diastolic mitral annular velocity) reflects the pulmonary wedge pressure, with a value of .15 heralding haemodynamic congestion. In patients complaining of dyspnoea but displaying an inconclusive E/E a , simple lower limb elevation for a few minutes is able to increase the preload, unmasking an abnormally high E/E a and haemodynamic pulmonary congestion. The opposite happens when the patient is asked to inflate an aneroid sphygmomanometer to the index 40 mmHg, when performing a Valsalva manoeuver. 6 An abnormal E/E a ratio which drops with decreased venous return suggests the need for further doses of diuretics. A high E/E a ratio not responding to the Valsalva manoeuvre probably indicates a pressure-not volume-overloaded left ventricle. Assessing the peripheral and pulmonary congestion in patients with (or without) heart failure is a continuous challenge. We further thank Gheorgiade and co-authors for giving us the opportunity to contribute to this provocative issue.

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Nocturia in males with heart failure: Prostatic edema and circadian neurohormonal rhythm

Cited by 10 publications

References 9 publications

Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

Sleep Disorders, Comorbidities, Actions, Lower Urinary Tract Dysfunction, and Medications (“Sleep C.A.L.M.”) in the evaluation and management of nocturia: A simple approach to a complex diagnosis

Quantifying the amount of congestion in heart failure

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