Background High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF. Methods A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or B. Plasma levels of cardiac troponin-I, brain natriuretic peptide, glomerular filtration rate by Modification of Diet in Renal Disease formula, bioelectrical impedance analysis measurements, and delta pressure/delta time (dP/dt) rate were observed on admission and discharge for all patients. Results We observed a significant reduction of cardiac troponin in both groups and a significant improvement in renal function, hydration state, pulmonary capillary wedge pressure (P b .0001), end diastolic volume (P b .01), ejection fraction (P b .01), and dP/dt (P b .004) in group A. We also observed a significant reduction in body weight (64.4 vs 75.8 kg) (P b .001), cardiac troponin I (0.02 vs 0.31 ng/mL) (P b .0001) and brain natriuretic peptide (542 vs 1,284 pg/mL) (P b .0001), and hospitalization time (6.25 vs 10.2 days) (P b .0001) in the HSS group. Conclusions These data demonstrate that intravenous high doses of furosemide do not increase myocardial injury and, in addition, when associated to HSS, significantly reduce cardiac troponin I release. This behavior is mirrored by the achievement of improved hemodynamic compensation at echocardiography and body hydration normalization

Parrinello, G., Di Pasquale, P., Torres, D., Cardillo, M., Schimmenti, C., Lupo, U., et al. (2012). Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur). AMERICAN HEART JOURNAL, 164(164), 351-357 [http://dx.doi.org/10.1016/j.ahj.2012.05.025].

Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur)

PARRINELLO, Gaspare;PATERNA, Salvatore
2012

Abstract

Background High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF. Methods A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or B. Plasma levels of cardiac troponin-I, brain natriuretic peptide, glomerular filtration rate by Modification of Diet in Renal Disease formula, bioelectrical impedance analysis measurements, and delta pressure/delta time (dP/dt) rate were observed on admission and discharge for all patients. Results We observed a significant reduction of cardiac troponin in both groups and a significant improvement in renal function, hydration state, pulmonary capillary wedge pressure (P b .0001), end diastolic volume (P b .01), ejection fraction (P b .01), and dP/dt (P b .004) in group A. We also observed a significant reduction in body weight (64.4 vs 75.8 kg) (P b .001), cardiac troponin I (0.02 vs 0.31 ng/mL) (P b .0001) and brain natriuretic peptide (542 vs 1,284 pg/mL) (P b .0001), and hospitalization time (6.25 vs 10.2 days) (P b .0001) in the HSS group. Conclusions These data demonstrate that intravenous high doses of furosemide do not increase myocardial injury and, in addition, when associated to HSS, significantly reduce cardiac troponin I release. This behavior is mirrored by the achievement of improved hemodynamic compensation at echocardiography and body hydration normalization
Settore MED/09 - Medicina Interna
Parrinello, G., Di Pasquale, P., Torres, D., Cardillo, M., Schimmenti, C., Lupo, U., et al. (2012). Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur). AMERICAN HEART JOURNAL, 164(164), 351-357 [http://dx.doi.org/10.1016/j.ahj.2012.05.025].
File in questo prodotto:
File Dimensione Formato  
tra-HSS-fur 2012 AmHJ.pdf

Solo gestori archvio

Dimensione 287.86 kB
Formato Adobe PDF
287.86 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10447/66423
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 17
  • ???jsp.display-item.citation.isi??? 17
social impact