Combining Loop and Thiazide Diuretics Across the Left Ventricular Ejection Fraction Spectrum

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2024-10-01 DOI:10.1016/j.jchf.2024.05.006

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引用次数: 0

Abstract

Background

The addition of hydrochlorothiazide (HCTZ) to furosemide in the CLOROTIC (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure) trial improved the diuretic response in patients with acute heart failure (AHF).

Objectives

This work aimed to evaluate if these results differ across the spectrum of left ventricular ejection fraction (LVEF).

Methods

This post hoc analysis of the randomized, double-blind, placebo-controlled CLOROTIC trial enrolled 230 patients with AHF to receive either HCTZ or a placebo in addition to an intravenous furosemide regimen. The influence of LVEF on primary and secondary outcomes was evaluated.

Results

The median LVEF was 55%: 166 (72%) patients had LVEF >40%, and 64 (28%) had LVEF ≤40%. Patients with a lower LVEF were younger, more likely to be male, had a higher prevalence of ischemic heart disease, and had higher natriuretic peptide levels. The addition of HCTZ to furosemide was associated with the greatest weight loss at 72 of 96 hours, better metrics of diuretic response, and greater 24-hour diuresis compared with placebo, with no significant differences according to the LVEF category (using 2 LVEF cutoff points: 40% and 50%) or LVEF as a continuous variable (all P values were insignificant). There were no significant differences observed with the addition of HCTZ in terms of mortality, rehospitalizations, or safety endpoints (impaired renal function, hyponatremia, and hypokalemia) among the 2 LVEF groups (all P values were insignificant).

Conclusions

Adding HCTZ to intravenous furosemide seems to be effective strategy for improving diuretic response in AHF without treatment effect modification according to baseline LVEF. (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure [CLOROTIC], NCT01647932; Randomized, double blinded, multicenter study, to asses Safety and Efficacy of the Combination of Loop With Thiazide-type Diuretics vs Loop diuretics with placebo in Patients With Decompensated, EudraCT Number 2013-001852-36)

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在左心室射血分数范围内联合使用襻利尿剂和噻嗪类利尿剂：CLOROTIC试验

背景：在CLOROTIC（针对失代偿性心力衰竭的襻袢利尿剂联合噻嗪类利尿剂）试验中，在呋塞米基础上加用氢氯噻嗪（HCTZ）可改善急性心力衰竭（AHF）患者的利尿反应：本研究旨在评估这些结果在不同的左心室射血分数（LVEF）范围内是否存在差异：这项对随机、双盲、安慰剂对照 CLOROTIC 试验的事后分析招募了 230 名急性心力衰竭患者，除静脉注射呋塞米治疗方案外，他们还接受了 HCTZ 或安慰剂治疗。研究评估了 LVEF 对主要和次要结果的影响：LVEF中位数为55%：166（72%）名患者的 LVEF >40%，64（28%）名患者的 LVEF ≤40%。LVEF 较低的患者更年轻，更可能是男性，缺血性心脏病发病率更高，钠尿肽水平更高。与安慰剂相比，在呋塞米基础上加用 HCTZ，72 小时和 96 小时体重减轻幅度最大，利尿反应指标更好，24 小时利尿量更大，但 LVEF 类别（使用两个 LVEF 临界点：40% 和 50%）或 LVEF 作为连续变量无显著差异（所有 P 值均不显著）。在死亡率、再住院率或安全终点（肾功能受损、低钠血症和低钾血症）方面，观察到添加HCTZ后两组LVEF之间无明显差异（所有P值均不显著）：结论：在静脉注射呋塞米的基础上添加 HCTZ 似乎是改善 AHF 利尿反应的有效策略，基线 LVEF 不会改变治疗效果。(将襻型利尿剂与噻嗪类利尿剂联合治疗失代偿性心力衰竭[CLOROTIC]，NCT01647932；随机、双盲、多中心研究，评估失代偿性心力衰竭患者襻型利尿剂与噻嗪类利尿剂联合治疗与襻型利尿剂与安慰剂联合治疗的安全性和有效性，EudraCT 编号 2013-001852-36）。

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.