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Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure.
J Card Fail. 2011 Apr; 17(4):331-9.JC

Abstract

BACKGROUND

The aim of the study was to verify the effects of hypertonic saline solution (HSS) plus a high furosemide dose and light restriction of sodium intake compared with a high-dose infusion of furosemide alone on pulmonary capillary wedge pressure (PCWP), as determined by Doppler echocardiography and tissue Doppler imaging in patients suffering from decompensated heart failure.

METHODS AND RESULTS

Consecutive patients in New York Heart Association functional class IV, unresponsive to oral high doses of furosemide up to 250-500 mg/d and/or combinations of diuretics, with ejection fraction <40%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, reduced urinary volume (<500 mL/24 h), and low natriuresis (<60 mEq/24 h) were randomized into 2 groups (double blind). The first group received a furosemide infusion (250 mg) plus HSS (150 mL 3.0% Na) bid and light Na restriction (120 mmol), and the second group received furosemide infusion (250 mg) twice daily, and low Na diet (80 mmol). The fluid intake of both groups was restricted (1 L/d). Body weight, whole-body bioelectrical impedance analysis (BIA), 24-hour urinary volume, and serum and urinary laboratory parameters were measured daily. Estimations of echocardiographic PCWP (Echo-PCWP) were detected on entry, 1 hour after concluding the initial treatment, and 6 days thereafter. A total of 133 patients (47 women and 86 men), aged 65-82 years, met the entry criteria.The HSS group revealed a significant increase in daily diuresis, natriuresis, and serum sodium compared with the furosemide group. Six days after treatment, renal function was significantly improved in the HSS group. Both groups showed a significant reduction in Echo-PCWP, but the HHS group revealed a faster reduction and significant lower values at 6 days compared with the group taking furosemide alone. We observed a positive correlation between values of Echo-PCWP and BNP and an inverse correlation between BIA parameters and Echo-PCWP.

CONCLUSIONS

Our data show that the combination of high diuretic dose and HSS infusion plus light restriction in dietary sodium intake determine a more rapid and significant hemodynamic stabilization through the improvement of echo-PCWP, BNP levels, and BIA parameters than the group treated without HSS.

Authors+Show Affiliations

Biomedical Department of Internal and Specialty Medicine, University of Palermo, Piazza delle Cliniche 2, Palermo, Italy. gaspare.parrinello@unipa.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

21440872

Citation

Parrinello, Gaspare, et al. "Changes in Estimating Echocardiography Pulmonary Capillary Wedge Pressure After Hypersaline Plus Furosemide Versus Furosemide Alone in Decompensated Heart Failure." Journal of Cardiac Failure, vol. 17, no. 4, 2011, pp. 331-9.
Parrinello G, Paterna S, Di Pasquale P, et al. Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure. J Card Fail. 2011;17(4):331-9.
Parrinello, G., Paterna, S., Di Pasquale, P., Torres, D., Mezzero, M., Cardillo, M., Fasullo, S., La Rocca, G., & Licata, G. (2011). Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure. Journal of Cardiac Failure, 17(4), 331-9. https://doi.org/10.1016/j.cardfail.2010.11.003
Parrinello G, et al. Changes in Estimating Echocardiography Pulmonary Capillary Wedge Pressure After Hypersaline Plus Furosemide Versus Furosemide Alone in Decompensated Heart Failure. J Card Fail. 2011;17(4):331-9. PubMed PMID: 21440872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure. AU - Parrinello,Gaspare, AU - Paterna,Salvatore, AU - Di Pasquale,Pietro, AU - Torres,Daniele, AU - Mezzero,Manuela, AU - Cardillo,Mauro, AU - Fasullo,Sergio, AU - La Rocca,Gabriella, AU - Licata,Giuseppe, Y1 - 2010/12/24/ PY - 2010/01/03/received PY - 2010/10/23/revised PY - 2010/11/02/accepted PY - 2011/3/29/entrez PY - 2011/3/29/pubmed PY - 2011/7/14/medline SP - 331 EP - 9 JF - Journal of cardiac failure JO - J Card Fail VL - 17 IS - 4 N2 - BACKGROUND: The aim of the study was to verify the effects of hypertonic saline solution (HSS) plus a high furosemide dose and light restriction of sodium intake compared with a high-dose infusion of furosemide alone on pulmonary capillary wedge pressure (PCWP), as determined by Doppler echocardiography and tissue Doppler imaging in patients suffering from decompensated heart failure. METHODS AND RESULTS: Consecutive patients in New York Heart Association functional class IV, unresponsive to oral high doses of furosemide up to 250-500 mg/d and/or combinations of diuretics, with ejection fraction <40%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, reduced urinary volume (<500 mL/24 h), and low natriuresis (<60 mEq/24 h) were randomized into 2 groups (double blind). The first group received a furosemide infusion (250 mg) plus HSS (150 mL 3.0% Na) bid and light Na restriction (120 mmol), and the second group received furosemide infusion (250 mg) twice daily, and low Na diet (80 mmol). The fluid intake of both groups was restricted (1 L/d). Body weight, whole-body bioelectrical impedance analysis (BIA), 24-hour urinary volume, and serum and urinary laboratory parameters were measured daily. Estimations of echocardiographic PCWP (Echo-PCWP) were detected on entry, 1 hour after concluding the initial treatment, and 6 days thereafter. A total of 133 patients (47 women and 86 men), aged 65-82 years, met the entry criteria.The HSS group revealed a significant increase in daily diuresis, natriuresis, and serum sodium compared with the furosemide group. Six days after treatment, renal function was significantly improved in the HSS group. Both groups showed a significant reduction in Echo-PCWP, but the HHS group revealed a faster reduction and significant lower values at 6 days compared with the group taking furosemide alone. We observed a positive correlation between values of Echo-PCWP and BNP and an inverse correlation between BIA parameters and Echo-PCWP. CONCLUSIONS: Our data show that the combination of high diuretic dose and HSS infusion plus light restriction in dietary sodium intake determine a more rapid and significant hemodynamic stabilization through the improvement of echo-PCWP, BNP levels, and BIA parameters than the group treated without HSS. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/21440872/Changes_in_estimating_echocardiography_pulmonary_capillary_wedge_pressure_after_hypersaline_plus_furosemide_versus_furosemide_alone_in_decompensated_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1071-9164(10)01191-7 DB - PRIME DP - Unbound Medicine ER -