Background: The reduced diuretic response is associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). However, the pathophysiologic importance of inadequately treated congestion and the neurohormonal sequelae of treatment with high doses of diuretics may differ based on the underlying cardiac structure and function.
Purpose: We sought to investigate the prognostic value of reduced diuretic response in ADHF patients, relating to preserved and reduced left ventricular ejection fraction(LVEF).
Methods: We prospectively enrolled consecutive 266 patients admitted for ADHF (LVEF: 46±15%) and discharged with survival (preserved LVEF≥45%[HFpEF] in 140 patients and reduced LVEF<45% [HFrEF] in 126 patients). Diuretic response was defined as weight loss per 40mg intravenous dose and 80mg oral dose of furosemide up to day 4. The endpoints were unplanned hospitalization for worsening heart failure (WHF).
Results: There was no significant difference in diuretic response between patient with HFpEF and HFrEF (2.5±4.5 vs 2.1±3.0 kg/40mg furosemide). During a mean follow up period of 2.2±1.5 years, 82 patients had WHF. A t multivariate Cox analysis, the diuretic response was significantly associated with WHF in patients with HFpEF independently of brain natriuretic peptide level, while the diuretic response showed no significant association with WHF in patients with HFrEF. Patients with poor diuretic response (≤1.511 kg/40mg furosemide determined by ROC anslysis: AUC 0.614 [95% CI 0.519-0.708]) had a significantly greater risk of WHF than those with good diuretic response (42% vs 21% p=0.019, adjust HR 2.237[1.14-4.389]) in HEpEF, but not in HErEF.
Conclusion: Poor diuretic response is associated with worsening heart failure in HFpEF, not in HFrEF