Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain.
Eur Heart J Acute Cardiovasc Care. 2022 Jun 7;11(4):350-355. doi: 10.1093/ehjacc/zuac006.
Patients with acute heart failure (AHF) require intensification in the diuretic strategy. However, the optimal diuretic strategy remains unclear. In this work, we aimed to evaluate the effect of chlorthalidone compared with spironolactone on diuretic efficacy and safety profile in a cohort of patients with AHF and preserved ejection fraction (AHF-pEF).
It was a prospective observational study in a single centre in Spain, included 44 consecutive patients admitted between June 2020 and March 2021, with AHF-pEF in which an additional diuretic was prescribed. The primary endpoint was changes in urinary sodium at 24 and 72 h, and the secondary were urine output, and other security endpoints. Mixed linear regression models were used to analyse the endpoints. Estimates were reported as least squares mean with their respective 95% confidence intervals. The median age of the study population was 85 years (82.5-88.5), and 30 (68.2%) were women. After multivariate analysis, the linear mixed regression analysis confirmed a greater natriuretic response of chlorthalidone over spironolactone, especially at 24 h (P = 0.009). Multivariate analysis also showed a greater cumulative diuretic response in those treated with chlorthalidone (P = 0.001). We did not find significant differences in glomerular filtration rate, serum sodium, and serum potassium at 72 h, neither significant differences were found in 24 and 72 h in systolic blood pressure.
In patients with AHF and left ventricular ejection fraction ≥50% receiving intravenous loop diuretics, chlorthalidone administration was associated with a greater short-term natriuresis.
急性心力衰竭（AHF）患者需要加强利尿剂策略。然而，最佳的利尿剂策略仍不清楚。在这项工作中，我们旨在评估与螺内酯相比，氯噻酮在射血分数保留的心力衰竭（AHF-pEF）患者队列中的利尿效果和安全性。
这是西班牙一家单中心的前瞻性观察性研究，纳入了 2020 年 6 月至 2021 年 3 月期间连续收治的 44 例 AHF-pEF 患者，这些患者均接受了额外的利尿剂治疗。主要终点是 24 小时和 72 小时尿钠的变化，次要终点是尿量和其他安全性终点。混合线性回归模型用于分析终点。估计值以最小二乘均值及其各自的 95%置信区间报告。研究人群的中位年龄为 85 岁（82.5-88.5），其中 30 名（68.2%）为女性。多变量分析后，线性混合回归分析证实氯噻酮的利尿效果优于螺内酯，特别是在 24 小时时（P=0.009）。多变量分析还表明，氯噻酮治疗的累积利尿反应更大（P=0.001）。我们在 72 小时时未发现肾小球滤过率、血清钠和血清钾有显著差异，也未发现 24 小时和 72 小时时收缩压有显著差异。
在接受静脉注射袢利尿剂的 AHF 且左心室射血分数≥50%的患者中，氯噻酮的给药与短期更强的排钠作用相关。
