© 2004 European Society of Cardiology
Clinical and neurohumoral consequences of diuretic withdrawal in patients with chronic, stabilized heart failure and systolic dysfunction
a Servei de Cardiologia, Hospital General Universitari Vall d'Hebron Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
b Servei de Bioquímica Hospital General Universitari Vall d'Hebron, Barcelona, Spain
* Corresponding author. Tel.: +34 93 274 6134; fax: +34 93 274 6063. E-mial address: egalve{at}vhebron.net
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Abstract |
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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Methods: Diuretics were withdrawn in 26 stabilized heart failure patients with systolic dysfunction (ejection fraction [EF]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.
Key Words: Heart failure • Diuretics • Neurohumoral activation
Received April 19, 2004; Revised September 14, 2004; Accepted September 20, 2004