Decongestion (instead of ultrafiltration?).

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Opinion in Cardiology Pub Date : 2024-05-01 Epub Date: 2024-02-16 DOI:10.1097/HCO.0000000000001124
Art Schuermans, Frederik H Verbrugge
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引用次数: 0

Abstract

Purpose of review: To summarize the contemporary evidence on decongestion strategies in patients with acute heart failure (AHF).

Recent findings: While loop diuretic therapy has remained the backbone of decongestive treatment in AHF, multiple randomized clinical trials suggest that early combination with other diuretic classes or molecules with diuretic properties should be considered. Mineralocorticoid receptor antagonists and sodium-glucose co-transporter-2 inhibitors are disease-modifying drugs in heart failure that favourably influence prognosis early on, advocating their start as soon as possible in the absence of any compelling contraindications. Short-term upfront use of acetazolamide in adjunction to intravenous loop diuretic therapy relieves congestion faster, avoids diuretic resistance, and may shorten hospitalization length. Thiazide-like diuretics remain a good option to break diuretic resistance. Currently, ultrafiltration in AHF remains mainly reserved for patient with an inadequate response to pharmacological treatment.

Summary: In most patients with AHF, decongestion can be achieved effectively and safely through combination diuretic therapies. Appropriate diuretic therapy may shorten hospitalization length and improve quality of life, but has not yet proven to reduce death or heart failure readmissions. Ultrafiltration currently has a limited role in AHF, mainly as bail-out strategy, but evidence for a more upfront use remains inconclusive.

减充血(而不是超滤?)
综述目的总结有关急性心力衰竭(AHF)患者减充血策略的最新证据:虽然襻利尿剂治疗仍是急性心力衰竭患者减充血治疗的主要手段,但多项随机临床试验表明,应考虑尽早联合使用其他利尿剂或具有利尿特性的分子。矿物皮质激素受体拮抗剂和钠-葡萄糖共转运体-2抑制剂是心力衰竭的疾病改变药物,可在早期对预后产生有利影响,因此,如果没有任何令人信服的禁忌症,应尽早开始使用。在静脉注射襻利尿剂的同时,先期短期使用乙酰唑胺可更快地缓解充血,避免出现利尿剂抵抗,并可缩短住院时间。噻嗪类利尿剂仍然是打破利尿剂耐药性的良好选择。小结:对于大多数 AHF 患者来说,通过联合利尿疗法可以有效、安全地缓解充血。适当的利尿剂治疗可缩短住院时间并改善生活质量,但尚未证明可减少死亡或心衰再住院率。超滤疗法目前在 AHF 中的作用有限,主要是作为一种保底策略,但是否更适合前期使用仍无定论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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