Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial
机构：[1]Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai 200336, China[2]Department of Cardiology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai 200336, China
Background: Ultrafiltration decreases total body water and improves the alveolar to arterial oxygen gradient. The aims of the study were to investigate the efficacy and safety of early ultrafiltration in acute decompensated heart failure (ADHF) patients. Methods: 100 patients with ADHF within 24 h of admission were randomly assigned into early ultrafiltration (n = 40) or torasemide plus tolvaptan (n = 60) groups. The primary outcomes were weight loss and an increase in urine output on days 4 and 8 of treatment. Results: Patients who received early ultrafiltration for 3 days achieved a greater weight loss (kg) (- 2.94 +/- 3.76 vs - 0.64 +/- 0.91,P < 0.001) and urine increase (mL) (198.00 +/- 170.70 vs 61.77 +/- 4.67,P < 0.001) than the torasemide plus tolvaptan group on day 4. From days 4 to 7, patients in the early ultrafiltration group received sequential therapy of torasemide and tolvaptan. Better control of volume was reflected in a greater weight loss (- 3.72 +/- 3.81 vs - 1.34 +/- 1.32,P < 0.001) and urine increase (373.80 +/- 120.90 vs 79.5 +/- 52.35,P < 0.001), greater reduction of B-type natriuretic peptide (BNP) (pg/mL) (- 1144 +/- 1435 vs - 654.02 +/- 889.65,P = 0.037), NYHA (New York Heart Association) functional class (- 1.45 +/- 0.50 vs - 1.17 +/- 0.62,P = 0.018), jugular venous pulse (JVP) score (points) (- 1.9 +/- 1.13 vs - 0.78 +/- 0.69,P < 0.001), inferior vena cava (IVC) diameter (mm) (- 15.35 +/- 11.03 vs - 4.98 +/- 6.00,P < 0.001) and an increase in the dyspnea score (points) (4.08 +/- 3.44 vs 2.77 +/- 2.03,P = 0.035) in the early ultrafiltration group on day 8. No significant differences were found in the readmission and mortality rates in the 2 patient groups at the 1-month and 3-month follow-ups. Both groups had a similar stable renal profile. Conclusion: Early ultrafiltration is superior to diuretics for volume overload treatment initiation of ADHF patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2000030696, Registered 10 March 2020-Retrospectively registered, https://www.chictr.org.cn/showproj.aspx?proj=29099.
基金：
Shanghai Changning District Health Commission,
Specialty in Acute Heart Failure (Grant No. 20062002).
第一作者机构：[1]Department of Critical Care Medicine (Specialty of Heart Failure), Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. 1111 Xianxia Road, Shanghai 200336, China
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推荐引用方式(GB/T 7714)：
Hu Jingyi,Wan Qianli,Zhang Yue,et al.Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial[J].BMC CARDIOVASCULAR DISORDERS.2020,20(1):doi:10.1186/s12872-020-01733-5.
APA：
Hu, Jingyi,Wan, Qianli,Zhang, Yue,Zhou, Jun,Li, Miaomiao...&Yuan, Fang.(2020).Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial.BMC CARDIOVASCULAR DISORDERS,20,(1)
MLA：
Hu, Jingyi,et al."Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure with volume overload: a prospective, randomized, controlled clinical trial".BMC CARDIOVASCULAR DISORDERS 20..1(2020)
