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Multiparametric assessment of “fluid status” in heart failure

  • Giuseppe Romano
    Correspondence
    Corresponding author at: Department for the Study and Treatment of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS, - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127 Palermo, Italy.
    Affiliations
    Cardiology Unit, Department for the Treatment and Study of Cardiothoracic, Diseases and Cardiothoracic Transplantation IRCCS, - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, 90127 Palermo, Italy
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  • Diego Bellavia
    Affiliations
    Cardiology Unit, Department for the Treatment and Study of Cardiothoracic, Diseases and Cardiothoracic Transplantation IRCCS, - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, 90127 Palermo, Italy
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  • Francesco Clemenza
    Affiliations
    Cardiology Unit, Department for the Treatment and Study of Cardiothoracic, Diseases and Cardiothoracic Transplantation IRCCS, - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, 90127 Palermo, Italy
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Published:September 14, 2017DOI:https://doi.org/10.1016/j.ejim.2017.09.016
      Usually in stable and asymptomatic patient with reduced ejection fraction the judgment to suspend or not diuretic therapy purely depend on clinical and intuitive evaluation and not on objective parameters. In clinical practice diuretic treatment in stable heart failure with reduced ejection fraction (HFrEF) patients is being used without clear evidence of major benefit on cardiovascular morbidity and mortality, due to the absence of adequately sized trials addressing these questions. In our study we support the concept that diuretics withdrawal should be performed in this HFrEF patients especially when adequate fluid balance is achieved [
      • Romano G.
      • Vitale G.
      • Bellavia D.
      • Agnese V.
      • Clemenza F.
      Is diuretic withdrawal safe in patients with heart failure and reduced ejection fraction? A retrospective analysis of our outpatients cohort.
      ]. This could not be the case of the aforementioned study [
      • Oshima K.
      • Kohsaka S.
      • Koide K.
      • Yoshikawa T.
      Reducing the dose of diuretics for heart failure patients: how low can it go?.
      ,
      • Jolobe O.M.P.
      Triple therapy can achieve striking reductions in frusemide dosage.
      ] for several reasons: In that study clinical data as well as critical echocardiographic measurements such as left ventricular ejection fraction, as well as other were not reported, so HF type (reduced vs preserved EF) and grading were not inferable. Finally, cardiac remodeling state or an estimate of cardiac filling pressures was not reported as well, so that no one can conclude study populations are indeed comparable.

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      References

        • Romano G.
        • Vitale G.
        • Bellavia D.
        • Agnese V.
        • Clemenza F.
        Is diuretic withdrawal safe in patients with heart failure and reduced ejection fraction? A retrospective analysis of our outpatients cohort.
        Eur J Intern Med. 2017; 42: e11-e13
        • Oshima K.
        • Kohsaka S.
        • Koide K.
        • Yoshikawa T.
        Reducing the dose of diuretics for heart failure patients: how low can it go?.
        Cardiology. 2009; 114: 89
        • Jolobe O.M.P.
        Triple therapy can achieve striking reductions in frusemide dosage.
        Cardiology. 2009; 114: 271