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Clinical and neurohumoral consequences of diuretic withdrawal in patients with chronic, stabilized heart failure and systolic dysfunction
Author(s) -
Galve Enrique,
Mallol Anna,
Catalan Robert,
Palet Jordi,
Méndez Stella,
Nieto Elsa,
Diaz Anna,
SolerSoler Jordi
Publication year - 2005
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2004.09.006
Subject(s) - medicine , heart failure , diuretic , blood pressure , cardiology , ejection fraction , loop diuretic , aldosterone , diastole , heart rate , endocrinology
Background Loop diuretics are beneficial in heart failure in the short term because they eliminate fluid retention, but in the long‐term, they could adversely influence prognosis due to activation of neurohumoral mechanisms. Aims To explore the changes induced by diuretic withdrawal in chronic nonadvanced heart failure. Methods Diuretics were withdrawn in 26 stabilized heart failure patients with systolic dysfunction (ejection fraction [EF]<45%). Clinical status was evaluated by physical exam, exercise capacity (corridor test) and New York Heart Association (NYHA) class. Biochemical and neurohumoral determinations were performed at baseline and at 3 months. Results At 3 months, 17 out of 26 patients (65%) were able to tolerate diuretic interruption without a deterioration in exercise capacity or New York Heart Association functional class. Renal function parameters improved (baseline urea 46.2±10.8 to 39.2±10.1 mg/dl at 3 months, p =0.014; creatinine 1.1±0.23 to 0.98±0.2 mg/dl, p =0.013). Glucose metabolism also improved (fasting glucose 151±91 to 122±14 mg/dl, p =0.035). Heart rate and systolic blood pressure did not significantly change, while diastolic blood pressure increased (from 80±10 to 87±13 mm Hg, p =0.006). Neurohumoral determinations showed a decrease in plasma renin activity (4.19±5.96 to 2.88±4.98 ng/ml, p =0.026), with no changes in aldosterone, arginine‐vasopressin, endothelin‐1 and norepinephrine. In contrast, atrial natriuretic peptide significantly increased (115±87 to 168±155 pg/ml, p =0.004). Conclusion Diuretic withdrawal in stabilized heart failure with systolic dysfunction is associated with an improvement in renal function parameters, glucose metabolism and some neurohumoral parameters, such as plasma renin activity; however, atrial natriuretic peptide levels increased.