Factors predicting diuretic resistance in patients with acute decompensated heart failure

Background

Heart failure is a leading cause of hospitalisation and mortality with high incidence and ever-increasing prevalence in the world. Although novel methods in management of acute decompensated heart failure (ADHF) have been developed, mortality and rehospitalisation rates remain high. Loop diuretics have been shown to be effective in relieving congestion and have been recommended in many heart failure guidelines. Continuous use of loop diuretics may cause complications in the form of diuretics resistance. The prevalence of diuretic resistance ranges from 20–35% in the heart failure population and has been shown to be a predictor of mortality and an increased incidence of hospitalisation. Until now there are debates in determining the clinical indicators of diuretic resistance. However, the clinical characteristics of patients with acute decompensated heart failure that predict the development of diuretic resistance have not been widely studied and previous studies have shown different results from one another.

Purpose

This study aims to identify factors that influence the occurrence of diuretic resistance in ADHF patients based on clinical profiles, medical histories, and laboratory findings.

Methods

This was a retrospective cohort study on patients treated due to ADHF from January-December 2019. Diuretic resistance was defined as a diuresis response less than 1400 ml in the first 24 hours after administration of 40 mg of intravenous furosemide.

Results

Data from 535 patients were analysed. The prevalence of diuretic resistance in this study was 68%. Independent predictors obtained from multivariate logistic regression analysis were Type II Diabetes Mellitus (p=0.013), history of prior iv loop diuretics >6 days (p=0.002), history of oral loop diuretic dose >80 mg/day (p=0.006), LVEF ≤49% (p=0.002), BUN ≥21 mg/dL (p<0.001) and serum chloride <98 mmol/L (p<0.001). In addition, a scoring system has been generated from the final model with AUC 0.749.

Conclusions

Independent predictors for diuretic resistance obtained from this study were DM, history of prior iv loop diuretics >6 days, history of oral loop diuretic dose >80 mg/day, LVEF ≤49%, BUN ≥21 mg/dL and serum chloride <98 mmol/L.

Funding Acknowledgement

Type of funding sources: None.

P194 Trimetazidine preserves right ventricular function on pulmonary arterial hypertension patients in national cardiovascular center harapan kita hospital indonesia

Funding Acknowledgements

National Cardiovascular Center Harapan Kita Hospital

Background

Right ventricular dysfunction is the worst mortality predictor in pulmonary arterial hypertension (PAH). Recent animal PAH studies have demonstrated the benefit of partial fatty acid inhibitor such as trimetazidine in improving right ventricular function. Therefore, we hypothesize that trimetazidine can improve right ventricular ejection fraction (RVEF) in PAH patients.

Purpose

Investigating the effect of  trimetazidine on right ventricle function in PAH patients.

Methods

We conducted 3 months randomized double blind placebo controlled trial on PAH patients at outpatient clinic in National Cardiovascular Center Harapan Kita Hospital Indonesia. Those who fulfilled the inclusion criteria will be randomized into trimetazidine or placebo group for 3 months on top of their standard PAH regime. Clinical and cardiovascular magnetic resonance imaging (CMR) parameters will be evaluated before and after 3 months therapy. The primary outcome of this study is the differences of RVEF from CMR.

Results

We randomly enrolled 26 PAH patients equally to receive placebo or trimetazidine for 3 months on top of their standard PAH regime. Total of 10 patients in each group was able to finish the study. There was significant improvement of RVEF in trimetazidine group 3.78 + 1.5% compared to placebo 2.76 + 1.6% (p 0.008, CI 1.96 to 10.96). Furthermore, we also observed improvement of functional capacity in trimetazidine group 0.24 + 0.09 compared to placebo -0.44 + 0.16 (p 0.002, CI 0.28 s/d 1.08).

Conclusions

Trimetazidine therapy for 3 months on top of standard PAH regime significantly improve RVEF and functional capacity in PAH patients.

Abstract P194 Figure. Effect of trimetazidine on RV function