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Restriction in fluid intake as a nonpharmacological tool for counteracting congestion in heart failure patients: A metaanalysis of randomized controlled trials
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Abstracts
we aimed to evaluate whether ligand-activated GPER may exert cardioprotective effects in male rats chronically treated with Dox. Materials and methods: Cardiac performance was examined ex vivo by using the Langendorff perfusion techniques at the end of the treatments, the involvement of intracellular pathways triggered by GPER activation was evaluated by Western Blotting. Results: After 1 week of intraperitoneal administration, G-1 (50 μg/kg/die) mitigated the adverse effects of Dox (3 mg/kg/die) on systolic recovery, infarct size and LDH levels. The cardioprotection induced by G-1 was associated with a reduction of apoptosis and by the switch-off of inflammatory processes (i.e. TNFalpha, IL1β). Conclusions: Our results suggest that the activation of GPER may mitigate the cardiotoxicity induced by Dox, hence GPER could be considered as a novel pharmacological target in order to lower the detrimental cardiac effects prompted by Dox treatment. doi:10.1016/j.vph.2015.11.022
Restriction in fluid intake as a nonpharmacological tool for counteracting congestion in heart failure patients: A metaanalysis of randomized controlled trials R. De Vecchisa,, C. Baldib, A. Fuscoa a Cardiology Unit, Presidio Sanitario Intermedio “Elena d'Aosta”, ASL Napoli 1 Centro, Napoli, Italy b Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy Objectives: The guidelines of the Scientific Societies of Cardiology suggest limiting water intake in the diet as one of the nonpharmacological measures for the management of chronic heart failure. However, irrefutable evidence that documents the efficacy of the limitation in water consumption on major cardiovascular outcomes is lacking. Therefore, we decided to perform a meta-analysis of studies that evaluated the efficacy and safety of the strategy of restricting water intake in the diet of patients with chronic heart failure. Materials and methods: The studies included in the metaanalysis had to be randomized controlled trial that compared patients with heart failure undergoing limitation in water consumption with patients who had free access to water intake. Primary outcomes of interest were heart failure hospitalizations and all-cause mortality. Secondary outcomes of interest were the sensation of thirst as measured by a visual analog scale, the duration of therapy with intravenous diuretics, and the serum levels of creatinine, sodium and B-type natriuretic peptide (BNP). The effect size was expressed as pooled odds ratio (OR) in the case of binary variables, and as weighted mean difference (WMD) in the case of continuous variables. Results: Six studies were incorporated into the meta-analysis. Significant heterogeneity was detected for the majority of investigated outcomes. Patients subjected to restricted fluid intake compared with patients admitted to free intake of beverages showed a similar rehospitalization rate (5 studies, pooled OR = 1.52; 95% CI: 0.67 to 3.43; p = 0.32) and a similar mortality rate (5 studies, pooled OR = 1.55; 95% CI: 0.87 to 2.75; p = 0.14). Likewise, there were no differences in regards to patients' sense of thirst (4 studies, WMD = −0.7; 95% CI: −2.58 to 1.17; p = 0.46), the duration of intravenous diuretic treatment (2 studies, WMD = 0.17 days; 95% CI: −1.26 to 1.6 days; p = 0.81), the serum creatinine levels (5 studies, WMD = 0.05 mg/dL; 95% CI: −0.16 to 0.26 mg/dL; p = 0.12), and serum sodium levels (5 studies, WMD = −0.86 mmol/L; 95% CI: −2.92 to 1.2 mmol/L; p = 0.41). By contrast, serum BNP levels were significantly higher in the group with free water intake (4 studies, WMD = 223.76 pg/mL; 95% CI: 158.8 to 288.72 pg/mL; p b 0.001). Conclusions: In patients with heart failure, liberal fluid consumption does not seem to exert an unfavorable impact on heart failure rehospitalization or all-cause mortality. Larger randomized controlled
trials would be warranted in the future to achieve definitive confirmation of the present findings, that substantially disavow any useful role of water restriction as a non-pharmacological measure for heart failure management. doi:10.1016/j.vph.2015.11.023
Cohen's kappa statistic for evaluating the concordance between different definitions of worsening renal function during acute decompensated heart failure. A retrospective study R. De Vecchisa,, C. Baldib, G. Di Biasec, C. Cioppaa a Cardiology Unit, Presidio Sanitario Intermedio “Elena d'Aosta”, ASL Napoli 1 Centro, Napoli, Italy b Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy c Neurorehabilitation Unit, Clinica “S. Maria del Pozzo”, Somma Vesuviana, Italy Objectives: Approximately one-third of patients with acute decompensated heart failure (ADHF) treated with an intravenous (iv) loop diuretic at a relatively high dose (N80 mg / day of furosemide, or an equivalent dose of another loop diuretic), exhibit worsening renal function (WRF) after a single course of iv infusions or iv bolus injections maintained for several days. WRF is currently defined as an increase in serum creatinine N 0.3 mg / dL (WRF—Cr) or a decrease in the glomerular filtration rate of ≥20% (WRF—GFR) compared to baseline measurements. Furthermore, small increases in serum creatinine in the high-normal range of its values are indicative of significant reductions in glomerular filtration rate (eGFR) due to the exponential relationship between serum creatinine and eGFR. Therefore, underestimating this relationship could lead to an erroneous quantitative estimate of new-onset renal dysfunction, diuretic-related. Materials and methods: The relationship between baseline serum creatinine (exposure variable) and the risk of diuretic related WRF (dichotomous outcome variable), expressed either as WRF—Cr or as WRF—GFR, was assessed by logistic regression analysis. For this purpose, medical records with a diagnosis of previous ADHF were collated, and retrospectively analyzed. The eGFR was calculated using the equation “Modification of Diet in Renal Disease” (MDRD). The WRF was inferred from measurements of serum creatinine that had been made daily during the scheduled courses of intravenous diuretic therapy. Results: Thirty-eight patients with chronic heart failure (CHF) and history of a previous episode of ADHF were enrolled in the study. An increase higher than 0.3 mg / dL of serum creatinine (WRF—Cr) was detected in 14 of 38 patients (36.8%). In addition, a decrease of ≥20% in GFR (WRF—GFR) was detected in 14 of 38 patients (36.8%). However, a poor concordance between the two criteria was found (Cohen's Kappa = 0.208, 95% CI: − 0.110 to 0.526). WRF—Cr and WRF—GFR showed opposing relations with baseline serum creatinine. In fact, the risk of WRF—Cr appeared positively associated with baseline serum creatinine (odds ratio = 33.56; 95% CI: 2.93–384.18 p = 0.0047), while the risk of WRF—GFR was inversely associated with the same analyte (odds ratio = 0.0393; 95% CI: 0.0039 to 0.3966 p = 0.0061). Conclusions: The criterion to discontinue the iv diuretic or to reduce its dosage in the presence of WRF—Cr for patients with ADHF or resistance to oral diuretic should be joined with the useful notion that this finding indicates a significant reduction of eGFR only for values of serum creatinine in the normal or near normal ranges. doi:10.1016/j.vph.2015.11.024
Abstracts
we aimed to evaluate whether ligand-activated GPER may exert cardioprotective effects in male rats chronically treated with Dox. Materials and methods: Cardiac performance was examined ex vivo by using the Langendorff perfusion techniques at the end of the treatments, the involvement of intracellular pathways triggered by GPER activation was evaluated by Western Blotting. Results: After 1 week of intraperitoneal administration, G-1 (50 μg/kg/die) mitigated the adverse effects of Dox (3 mg/kg/die) on systolic recovery, infarct size and LDH levels. The cardioprotection induced by G-1 was associated with a reduction of apoptosis and by the switch-off of inflammatory processes (i.e. TNFalpha, IL1β). Conclusions: Our results suggest that the activation of GPER may mitigate the cardiotoxicity induced by Dox, hence GPER could be considered as a novel pharmacological target in order to lower the detrimental cardiac effects prompted by Dox treatment. doi:10.1016/j.vph.2015.11.022
Restriction in fluid intake as a nonpharmacological tool for counteracting congestion in heart failure patients: A metaanalysis of randomized controlled trials R. De Vecchisa,, C. Baldib, A. Fuscoa a Cardiology Unit, Presidio Sanitario Intermedio “Elena d'Aosta”, ASL Napoli 1 Centro, Napoli, Italy b Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy Objectives: The guidelines of the Scientific Societies of Cardiology suggest limiting water intake in the diet as one of the nonpharmacological measures for the management of chronic heart failure. However, irrefutable evidence that documents the efficacy of the limitation in water consumption on major cardiovascular outcomes is lacking. Therefore, we decided to perform a meta-analysis of studies that evaluated the efficacy and safety of the strategy of restricting water intake in the diet of patients with chronic heart failure. Materials and methods: The studies included in the metaanalysis had to be randomized controlled trial that compared patients with heart failure undergoing limitation in water consumption with patients who had free access to water intake. Primary outcomes of interest were heart failure hospitalizations and all-cause mortality. Secondary outcomes of interest were the sensation of thirst as measured by a visual analog scale, the duration of therapy with intravenous diuretics, and the serum levels of creatinine, sodium and B-type natriuretic peptide (BNP). The effect size was expressed as pooled odds ratio (OR) in the case of binary variables, and as weighted mean difference (WMD) in the case of continuous variables. Results: Six studies were incorporated into the meta-analysis. Significant heterogeneity was detected for the majority of investigated outcomes. Patients subjected to restricted fluid intake compared with patients admitted to free intake of beverages showed a similar rehospitalization rate (5 studies, pooled OR = 1.52; 95% CI: 0.67 to 3.43; p = 0.32) and a similar mortality rate (5 studies, pooled OR = 1.55; 95% CI: 0.87 to 2.75; p = 0.14). Likewise, there were no differences in regards to patients' sense of thirst (4 studies, WMD = −0.7; 95% CI: −2.58 to 1.17; p = 0.46), the duration of intravenous diuretic treatment (2 studies, WMD = 0.17 days; 95% CI: −1.26 to 1.6 days; p = 0.81), the serum creatinine levels (5 studies, WMD = 0.05 mg/dL; 95% CI: −0.16 to 0.26 mg/dL; p = 0.12), and serum sodium levels (5 studies, WMD = −0.86 mmol/L; 95% CI: −2.92 to 1.2 mmol/L; p = 0.41). By contrast, serum BNP levels were significantly higher in the group with free water intake (4 studies, WMD = 223.76 pg/mL; 95% CI: 158.8 to 288.72 pg/mL; p b 0.001). Conclusions: In patients with heart failure, liberal fluid consumption does not seem to exert an unfavorable impact on heart failure rehospitalization or all-cause mortality. Larger randomized controlled
trials would be warranted in the future to achieve definitive confirmation of the present findings, that substantially disavow any useful role of water restriction as a non-pharmacological measure for heart failure management. doi:10.1016/j.vph.2015.11.023
Cohen's kappa statistic for evaluating the concordance between different definitions of worsening renal function during acute decompensated heart failure. A retrospective study R. De Vecchisa,, C. Baldib, G. Di Biasec, C. Cioppaa a Cardiology Unit, Presidio Sanitario Intermedio “Elena d'Aosta”, ASL Napoli 1 Centro, Napoli, Italy b Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy c Neurorehabilitation Unit, Clinica “S. Maria del Pozzo”, Somma Vesuviana, Italy Objectives: Approximately one-third of patients with acute decompensated heart failure (ADHF) treated with an intravenous (iv) loop diuretic at a relatively high dose (N80 mg / day of furosemide, or an equivalent dose of another loop diuretic), exhibit worsening renal function (WRF) after a single course of iv infusions or iv bolus injections maintained for several days. WRF is currently defined as an increase in serum creatinine N 0.3 mg / dL (WRF—Cr) or a decrease in the glomerular filtration rate of ≥20% (WRF—GFR) compared to baseline measurements. Furthermore, small increases in serum creatinine in the high-normal range of its values are indicative of significant reductions in glomerular filtration rate (eGFR) due to the exponential relationship between serum creatinine and eGFR. Therefore, underestimating this relationship could lead to an erroneous quantitative estimate of new-onset renal dysfunction, diuretic-related. Materials and methods: The relationship between baseline serum creatinine (exposure variable) and the risk of diuretic related WRF (dichotomous outcome variable), expressed either as WRF—Cr or as WRF—GFR, was assessed by logistic regression analysis. For this purpose, medical records with a diagnosis of previous ADHF were collated, and retrospectively analyzed. The eGFR was calculated using the equation “Modification of Diet in Renal Disease” (MDRD). The WRF was inferred from measurements of serum creatinine that had been made daily during the scheduled courses of intravenous diuretic therapy. Results: Thirty-eight patients with chronic heart failure (CHF) and history of a previous episode of ADHF were enrolled in the study. An increase higher than 0.3 mg / dL of serum creatinine (WRF—Cr) was detected in 14 of 38 patients (36.8%). In addition, a decrease of ≥20% in GFR (WRF—GFR) was detected in 14 of 38 patients (36.8%). However, a poor concordance between the two criteria was found (Cohen's Kappa = 0.208, 95% CI: − 0.110 to 0.526). WRF—Cr and WRF—GFR showed opposing relations with baseline serum creatinine. In fact, the risk of WRF—Cr appeared positively associated with baseline serum creatinine (odds ratio = 33.56; 95% CI: 2.93–384.18 p = 0.0047), while the risk of WRF—GFR was inversely associated with the same analyte (odds ratio = 0.0393; 95% CI: 0.0039 to 0.3966 p = 0.0061). Conclusions: The criterion to discontinue the iv diuretic or to reduce its dosage in the presence of WRF—Cr for patients with ADHF or resistance to oral diuretic should be joined with the useful notion that this finding indicates a significant reduction of eGFR only for values of serum creatinine in the normal or near normal ranges. doi:10.1016/j.vph.2015.11.024