Abstract: PO1804
Diuretic Resistance in Acute Decompensated Heart Failure with Preserved vs. Reduced Ejection Fraction
Session Information
- Hypertension and CVD: Clinical, Outcomes, and Trials
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Sharma, Akash, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Patel, Rahul, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Velagapudi, Chakradhar, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Bansal, Shweta, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Background
Loop diuretic resistance (DR) is one of the common causes of inadequate decongestion in patients hospitalized with acute decompensated heart failure (ADHF). However, DR has not been characterized in patients with HF with preserved ejection fraction (HFpEF).
Methods
In a post hoc analysis of a pilot study which evaluated the role of high-dose spironolactone in hospitalized ADHF patients with DR, we analyzed the prevalence and potential pathophysiologic factors of DR in HFpEF (n=20), and compared those with HF with reduced EF (HFrEF) (n=27). DR was defined as weight loss<1lb/day despite intravenous furosemide>160mg/day (at least one dose of 80mg/day) or no change in dyspnea 48H after admission with usual care.
Results
DR was observed in 10 (50%) of HFpEF subjects as compared to 10 (37%) of HFrEF subjects (p=ns). In general, patients with HFpEF were older, more female and obese, had more diabetes, higher systolic blood pressure and lower brain natriuretic peptide compared to HFrEF (Table 1). There was no difference in clinical presentation, eGFR and pulmonary arterial systolic pressure in DR-HFpEF vs. DR-HFrEF. However, urine sodium/potassium ratio, plasma renin activity and aldosterone were lower in DR-HFpEF as compared to DR-HFrEF, though still higher than diuretic responsive-HFpEF patients (Table 1). Weight loss in response to high-dose spironolactone was similar in DR-HFpEF and HFrEF (14±8.6 vs.14±13 lb).
Conclusion
Although the comparisons were not statistically significant due to small sample size; the results suggest that DR is more prevalent in HFpEF. Despite similar clinical features of congestion and response to high-dose spironolactone, a state of reduced neurohormonal activation points that additional factors might be contributing to DR in HFpEF compared to HFrEF patients.
Table 1: Baseline characteristics of HFrEF vs. HFpEF patients
| RS-HFrEF (n=17) | DR-HFrEF (n=10) | Total, HFrEF (n=27) | RS-HFpEF (n=10) | DR-HFpEF (n=10) | Total, HFpEF (n=20) | p-value | |
| Age Male (%) Body Mass Index (kg/m2) | 55 (11.1) 88 28.7 (4.2) | 56 (14.8) 80 28.7 (8.3) | 55 (12.3) 85 28.7 (6.0) | 55 (11.6) 60 38 (9.3) | 68 (15.7) 50 36.8 (7.6) | 61 (15.0) 55 37.4 (8.4) | ns <0.001 ns |
| Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Peripheral Edema (%) Pulmonary rales (%) | 125 (20.7) 78 (15.5) 64.7 82.4 | 115 (18.5) 76 (14.8) 100 60 | 121 (20.2) 77 (15.0) 77.8 74 | 138.2 (14.9) 76.9 (17.2) 100 80 | 131.6 (21.8) 69 (10.6) 90 80 | 134.9 (18.5) 73 (14.5) 95 80 | ns ns ns <0.001 |
| Diabetes CKD (eGFR <60 ml/min) | 29 59 | 30 60 | 30 59 | 60 50 | 70 70 | 65 60 | <0.001 ns |
| eGFR (ml/min/1.73m2) Urine Sodium/potassium ratio Pulmonary congestion on X-ray (%) PASP on ECHO (mmHg) | 61.6 (17.8) 7.59 (4.9) 88.2 43 (10.0) | 60.2 (22.8) 4.25 (3.9) 80 45 (9.9) | 61.0 (19.4) 6.26 (4.8) 85.2 44 (9.9) | 68.4 (22.5) 5.30 (4.5) 80 40 (8.4) | 54.3 (29.6) 2.48 (1.2) 80 50 (13.5) | 61.4 (26.6) 3.89 (3.5) 80 45 (12.1) | ns ns ns ns |
| Brain natriuretic peptide (pg/mL) Renin activity (ng/mL/hour) Aldosterone (ng/dL) Antidiuretic hormone (pq/mL) Epinephrine (pq/mL) Norepinephrine (pq/mL) | 1637 (2224) 2.50 (8.6) 5.20 (3.6) 4.00 (4.3) 35.50 (43.8) 730.5 (840.3) | 1255 (783) 10.6 (37.1) 42.20 (32) 4.10 (4.1) 74 (116) 1557 (410) | 1527 (1973.5) 6.90 (12.8) 7.90 (20.3) 4.00 (4.6) 42.00 (58) 849.50 (1005.3) | 467 (604) 0.65 (3.9) 3.95 (3.6) 1.15 (1.7) 16.00 (19.8) 533.50 (295.3) | 406 (310.8) 3.75 (9.3) 14.30 (17.6) 1.35 (1.5) 31.00 (22) 864.50 (322.8) | 449 (330.5) 1.15 (9.6) 7.55 (12.3) 1.35 (1.9) 18.00 (26) 734.50 (443.3) | ns ns ns ns ns ns |
RS=Responsive, DR=Diuretic Resistant
Funding
- Commercial Support –