Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Am Coll Cardiol. 2023 May 23;81(20):2013-2024. doi: 10.1016/j.jacc.2023.03.400.
Acetazolamide facilitates decongestion in acute decompensated heart failure (ADHF).
This study sought to investigate the effect of acetazolamide on natriuresis in ADHF and its relationship with outcomes.
Patients from the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial with complete data on urine output and urine sodium concentration (UNa) were analyzed. Predictors of natriuresis and its relationship with the main trial endpoints were evaluated.
This analysis included 462 of 519 patients (89%) from the ADVOR trial. During 2 days after randomization, UNa was 92 ± 25 mmol/L on average, and total natriuresis was 425 ± 234 mmol. Allocation to acetazolamide strongly and independently predicted natriuresis with a 16 mmol/L (19%) increase in UNa and 115 mmol (32%) greater total natriuresis. Higher systolic blood pressure, better renal function, higher serum sodium levels, and male sex also independently predicted both a higher UNa and greater total natriuresis. A stronger natriuretic response was associated with faster and more complete relief of signs of volume overload, and this effect was already significant on the first morning of assessment (P = 0.022). A significant interaction was observed between the effect of allocation to acetazolamide and UNa on decongestion (P = 0.007). Stronger natriuresis with better decongestion translated into a shorter hospital stay (P < 0.001). After multivariable adjustments, every 10 mmol/L UNa increase was independently associated with a lower risk of all-cause death or heart failure readmission (HR: 0.92; 95% CI: 0.85-0.99).
Increased natriuresis is strongly related to successful decongestion with acetazolamide in ADHF. UNa may be an attractive measure of effective decongestion for future trials. (Acetazolamide in Decompensated Heart Failure with Volume Overload [ADVOR]; NCT03505788).
乙酰唑胺有助于急性失代偿性心力衰竭（ADHF）的充血消退。
本研究旨在探讨乙酰唑胺对 ADHF 患者排钠作用及其与结局的关系。
对 ADVOR（伴有容量超负荷的失代偿性心力衰竭中的乙酰唑胺）试验中具有完整尿量和尿钠浓度（UNa）数据的患者进行分析。评估排钠作用的预测因素及其与主要试验终点的关系。
本分析纳入 ADVOR 试验中的 519 例患者中的 462 例（89%）。随机分组后 2 天，平均 UNa 为 92 ± 25 mmol/L，总排钠量为 425 ± 234 mmol。乙酰唑胺的分配强烈且独立地预测了排钠作用，使 UNa 增加 16 mmol/L（19%），总排钠量增加 115 mmol（32%）。较高的收缩压、较好的肾功能、较高的血清钠水平和男性也独立预测了更高的 UNa 和更大的总排钠量。更强的排钠反应与更快和更完全的容量超负荷缓解相关，这种影响在评估的第一个早晨就已经很明显（P=0.022）。在分配给乙酰唑胺的效果和 UNa 对充血消退的影响之间观察到显著的交互作用（P=0.007）。更强的排钠作用和更好的充血消退导致住院时间缩短（P<0.001）。经过多变量调整，每增加 10 mmol/L 的 UNa 与全因死亡或心力衰竭再入院的风险降低相关（HR：0.92；95%CI：0.85-0.99）。
在 ADHF 中，乙酰唑胺治疗后排钠量的增加与充血消退密切相关。UNa 可能是未来试验中有效充血消退的一个有吸引力的指标。（伴有容量超负荷的失代偿性心力衰竭中的乙酰唑胺[ADVOR]；NCT03505788）。
