Acetazolamide as a decongestion strategy in acute decompensated heart failure: Balancing fluid removal and electrolyte disturbances.
Acetazolamide as a decongestion strategy in acute decompensated heart failure: Balancing fluid removal and electrolyte disturbances.
复制标题
乙酰唑胺作为急性失代偿性心力衰竭的减充血策略：平衡液体清除和电解质紊乱。
DOI：
10.1002/ejhf.2935
复制
发表时间：
2023
影响因子：
18.2
通讯作者：
Ambrosy,AndrewP
中科院分区：
文献类型：
--
作者：
Butte,Zara;Ambrosy,AndrewP
心衰（HF）是一个全球性的公共卫生问题，大约三分之一的欧洲人在55岁以上患有心衰。此外，在欧洲，每年因心衰住院的人数超过100万，并可能在随后的一年中带来高达20-30%的死亡率风险。3,4住院心衰管理的一个主要组成部分是容量控制，患者在出院时经常与残余充血作斗争，导致生活质量受损和门诊功能限制。目前，尽管循环利尿剂仍然是住院心衰治疗的基石，但缺乏循证的消血策略和明确定义的终点来指导治疗时间。乙酰唑胺在失代偿性心力衰竭伴容量过载（ADVOR）试验中评估了乙酰唑胺作为急性失代偿性心衰（ADHF）患者循环利尿剂治疗的疗效和安全性，并与常规标准治疗进行了比较。简而言之，随机分配接受乙酰唑胺治疗的患者在第3天成功实现了临床去充血，住院时间也较短，但在3个月时HF再住院或全因死亡率方面没有显著差异。此外，没有证据表明乙酰唑胺加环状利尿剂治疗后会出现临床显著的低钾血症或低钠血症。7-9 ADVOR研究是一项多中心、双盲、随机对照试验，于2018-2022年在比利时的27个地点进行。7-9例纳入的患者为年龄为> - 18岁的ADHF成年患者，且表现为1)一个以上容积超载的临床体征（即> - 2+点状水肿，超声显示的腹水或胸片显示的胸腔积液），2)利钠肽升高，以及3)先前接受低剂量口服维持利尿剂治疗超过一个月。如果患者有新诊断的HF（即新生），正在接受SGLT-2抑制剂治疗，或者在住院期间接受了更高剂量的静脉袢利尿剂，则排除患者，其定义为布美他尼> 2mg,> 80mg
Heart failure (HF) is a global public health problem with about one-third of Europeans developing HF over the age of 55. 1, 2 Furthermore, hospitalizations for HF account for over a million admissions annually in Europe and may carry a risk of mortality as high as 20-30% in the subsequent year. 3, 4 A major component of inpatient HF management is volume control, and patients often struggle with residual congestion at discharge resulting in impairments in quality of life and functional limitations as an outpatient. 5, 6 Currently, there is a lack of evidence-based decongestion strategies and clearly defined endpoints to guide treatment duration, although loop diuretics remain the cornerstone of inpatient HF management. The Acetazolamide in Decompensated Heart Failure with Volume Overload (ADVOR) trial evaluated the efficacy and safety of acetazolamide as an adjunct to loop diuretic therapy in patients with acute decompensated HF (ADHF) compared to usual standard of care. In short, the patients randomly assigned to receive acetazolamide reached successful clinical decongestion on day 3, as well as had a shorter length of stay, but did not have a meaningful difference in rehospitalization for HF or all-cause mortality at 3 months. Furthermore, there was no evidence of clinically significant hypokalemia or hyponatremia when treated with acetazolamide in addition to loop diuretics. 7-9The ADVOR study was a multicenter, double-blind, randomized controlled trial set across 27 sites in Belgium between 2018-2022. 7-9 Patients were eligible for enrollment if they were adult patients> 18 years admitted for ADHF and presented with 1) more than one clinical sign of volume overload (ie, defined as> 2+ pitting edema, ascites on ultrasound, or pleural effusion on chest x-ray), 2) elevated natriuretic peptide, and 3) prior low-dose oral maintenance diuretic therapy for more than a month. Patients were excluded if they had newly diagnosed HF (ie, de novo), were on SGLT-2 inhibitor therapy, or if they received higher doses of IV loop diuretics during hospitalization, which was defined as either> 2 mg bumetanide,> 80 mg