Insuficiencia cardiaca aguda, de la evolución del concepto de la congestión al tratamiento

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Palabras clave

Insuficiencia cardiaca aguda
Síndrome cardiorenal
Resistencia a los diuréticos
Congestión

Cómo citar

1.
Morejón Barragán P, Peradejordi Lastras M. Insuficiencia cardiaca aguda, de la evolución del concepto de la congestión al tratamiento. RevMICG [Internet]. 29 de diciembre de 2020 [citado 27 de febrero de 2024];1(1):13 - 26. Disponible en: https://revistaclinicaguayaquil.org/index.php/revclinicaguaya/article/view/57

Resumen

La insuficiencia cardiaca (IC) es una pandemia que contribuye en gran parte a la morbi-mortalidad cardiovascular, esta entidad nos enfrenta a grandes retos durante los episodios de descompensación o la IC aguda (ICA). Conocemos que una de sus principales características es la congestión, la misma que con el tiempo ha necesitado ser reinterpretada, sobre todo por su relevancia en el mecanismo fisiopatológico del denominado Síndrome Cardiorrenal (SCR). Estos últimos años nos han permitido o, al menos hemos intentado, comprender la interacción corazón-riñón, la misma que tiene particular atención por una consecuencia inmediata, la resistencia a los diuréticos (RD). Estas características propias de la IC, congestión, descompensaciones, y compromiso de otros órganos, son predictores independientes de eventos adversos en ICA. El enfoque de la interacción de estos dos órganos va más allá de la tasa de filtrado glomerular (TFG) y nuestra obsesión de evaluarla únicamente con la interpretación de la creatinina. La presencia de RD es secundaria a múltiples causas, sin embargo, aún desconocemos si prevenirla es el camino. Ante esta combinación de sucesos, el tratamiento farmacológico en la fase aguda tiene como pilar principal a los diuréticos, fármacos que no han demostrado modificar el curso de la enfermedad, pero que al actuar en el proceso de descongestión, probablemente como punto subrogado, merece otro análisis considerando lo positivo que representa descongestionar a los pacientes. En el manejo de la ICA el tratamiento basado en evidencia lamentablemente es esquivo, y el empirismo razonado predomina, es momento de actuar.

https://doi.org/10.51597/rmicg.v1i1.57
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Referencias bibliográficas

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200.

Kociol RD, McNulty SE, Hernandez AF, Lee KL, Redfield MM, Tracy RP, et al. Markers of decongestion, dyspnea relief, and clinical outcomes among patients hospitalized with acute heart failure. Circ Hear Fail. 2013;6(2):240–5.

Lala A, McNulty SE, Mentz RJ, Dunlay SM, Vader JM, AbouEzzeddine OF, et al. Relief and recurrence of congestion during and after hospitalization for acute heart failure insights from diuretic optimization strategy evaluation in acute decompensated heart failure (DOSE-AHF) and cardiorenal rescue study in acute decompensated heart . Circ Hear Fail. 2015;8(4):741–8.

Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure. J Am Coll Cardiol. 2009;53(7):589–96.

Wattad M, Darawsha W, Solomonica A, Hijazi M, Kaplan M, Makhoul BF, et al. Interaction between worsening renal function and persistent congestion in acute decompensated heart failure. Am J Cardiol. 2015;115(7):932–7.

Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo-Leiro MG, et al. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long- Term Registry. Eur J Heart Fail. 2017;19(10):1242– 54.

Costanzo MR. Verdict In. Congestion Guilty! JACC Hear Fail. 2015; 3(10):762–4.

Llauger L, Jacob J, Herrero-Puente P, Aguirre A, Suñén-Cuquerella G, Corominas-Lasalle G, et al. The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department. Eur Hear J Acute Cardiovasc Care. 2020;9(5):406-418

Filippatos G, Angermann CE, Cleland JGF, Lam CSP, Dahlström U, Dickstein K, et al. Global Differences in Characteristics, Precipitants, and Initial Management of Patients Presenting with Acute Heart Failure. JAMA Cardiol. 2020;5(4):401– 10.

Boorsma EM, ter Maaten JM, Damman K, Dinh W, Gustafsson F, Goldsmith S, et al. Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol. 2020;Online ahead of print.

Čelutkienė J, Lainscak M, Anderson L, Gayat E, Grapsa J, Harjola VP, et al. Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22(2):181–95.

Le VK, Beruar A, Liu H, Sadreddini M, Salehian O. Role of Cardiac Auscultation in the Era of Portable Handheld Ultrasound. Can J Cardiol. 2020;36(2):147–50.

Buessler A, Chouihed T, Duarte K, Bassand A, Huot-Marchand M, Gottwalles Y, et al. Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the ED: A Multicenter Prospective Study. Chest. 2020;157(1):99–110.

Chaudhry SI, Wang Y, Concato J, Gill TM, Krumholz HM. Patterns of weight change preceding hospitalization for heart failure. Circulation. 2007;116(14):1549–54.

Stevenson LW, Perloff JK. The Limited Reliability of Physical Signs for Estimating Hemodynamics in Chronic Heart Failure. JAMA J Am Med Assoc. 1989;261(6):884–8.

Kelder JC, Cramer MJ, Van Wijngaarden J, Van Tooren R, Mosterd A, Moons KGM, et al. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation. 2011;124(25):2865–73.

Chakko S, Woska D, Martinez H, Marchena E de, Futterman L, Kessler K, et al. . Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med. 1991;90:353–9.

Felker GM, Anstrom KJ, Adams KF, Ezekowitz JA, Fiuzat M, Houston-Miller N, et al. Effect of natriuretic peptide–guided therapy on hospitalization or cardiovascular mortality in high-risk patients with heart failure and reduced ejection fraction: A randomized clinical trial. JAMA - J Am Med Assoc. 2017;318(8):713–20.

Yoon JY, Yang DH, Cho HJ, Kim NK, Kim CY, Son J, et al. Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure. Korean J Intern Med. 2019; 34(4):811–8.

Núñez J, Llàcer P, Bertomeu-González V, Bosch MJ, Merlos P, García-Blas S, et al. Carbohydrate Antigen-125–Guided Therapy in Acute Heart Failure: CHANCE-HF: A Randomized Study. JACC Hear Fail. 2016;4(11):833–43.

Núñez J, Núñez E, Bayés-Genís A, Fonarow GC, Miñana G, Bodí V, et al. Long-term serial kinetics of N-terminal pro B-type natriuretic peptide and carbohydrate antigen 125 for mortality risk prediction following acute heart failure. Eur Hear journal Acute Cardiovasc care. 2017;6(8):685–96.

Ceriani E, Casazza G, Peta J, Torzillo D, Furlotti S, Cogliati C. Residual congestion and long-term prognosis in acutely decompensated heart failure patients. Intern Emerg Med. 2020;

Cardio-Renal Connections in Heart Failure and Cardiovascular Disease | NHLBI, NIH.

Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal Syndrome. J Am Coll Cardiol. 2008;52:1527–39.

Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, et al. Cardio- renal syndromes: Report from the consensus conference of the acute dialysis quality initiative. In: Eur Heart J. 2010;31(6):703–711.

Ruggenenti P, Remuzzi G. Worsening kidney function in decompensated heart failure: Treat the heart, dont mind the kidney. Vol. 32, European Heart Journal. Eur Heart J. 2011;32(20):2476-8.

Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal Impairment and Outcomes in Heart Failure. Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2006; 47(10):1987–96.

Metra M, Davison B, Bettari L, Sun H, Edwards C, Lazzarini V, et al. Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Hear Fail. 2012; 5(1):54–62.

Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco- Bacik MA, Chen HH, et al. Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury. Circulation. 2018; 137(19):2016–28.

Bleske BE, Clark MM, Wu AH, Dorsch MP. The effect of continuous infusion loop diuretics in patients with acute decompensated heart failure with hypoalbuminemia. J Cardiovasc Pharmacol Ther. 2013; 18(4):334–7.

Ellison DH. Diuretic Therapy and Resistance in Congestive Heart Failure. Cardiology. 2002; 96(3– 4):132–43.

Ellison DH, Felker GM. Diuretic Treatment in Heart Failure. N Engl J Med. 2017; 377(20):1964–75.

Gandhi S, Mosleh W, Myers RBH. Hypertonic saline with furosemide for the treatment of acute congestive heart failure: A systematic review and meta-analysis. Int J Cardiol. 2014; 173(2):139–45.

Griffin M, Soufer A, Goljo E, Colna M, Rao VS, Jeon S, et al. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center’s Experience. JACC Hear Fail. 2020;8(3):199–208.

Cuthbert JJ, Pellicori P, Rigby A, Pan D, Kazmi S, Shah P, et al. Low serum chloride in patients with chronic heart failure: clinical associations and prognostic significance. Eur J Heart Fail. 2018; 20(10):1426–35.

Marchenko R, Sigal A, Wasser TE, Reyer J, Green J, Mercogliano C, et al. Hypochloraemia and 30 day readmission rate in patients with acute decompensated heart failure. ESC Hear Fail. 2020 Jun;7(3):903–7.

Ter Maaten JM, Valente MAE, Damman K, Hillege HL, Navis G, Voors AA. Diuretic response in acute heart failure - Pathophysiology, evaluation, and therapy. Nat Rev Cardiol. 2015;12(3):184–92.

Testani JM, Brisco MA, Turner JM, Spatz ES, Parikh CR, Tang WHW. Loop Diuretic Efficiency: A Metric of Diuretic Responsiveness with Prognostic Importance in Acute Decompensated Heart Failure. Circ Hear Fail. 2014;7(2):261–70.

ter Maaten JM, Rao VS, Hanberg JS, Perry Wilson F, Bellumkonda L, Assefa M, et al. Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure. Eur J Heart Fail. 2017;19(8):1014–22.

Valente MAE, Voors AA, Damman K, Veldhuisen DJ Van, Massie BM, Connor CMO, et al. Diuretic response in acute heart failure: clinical characteristics and prognostic significance. Eur Heart J. 2014;35(19):1284–93.

Voors AA, Davison BA, Teerlink JR, Felker GM, Filippatos G, Greenberg BH, et al. Diuretic response in patients with acute decompensated heart failure : characteristics and clinical outcome — an analysis from RELAX-AHF. Eur J Heart Fail. 2014;11(16):230–40.

Maaten J Ter, Dunning A, Valente MAE, Damman K, Ezekowitz J, Califf R, et al. Diuretic response in acute heart failure: An analysis from ASCEND-HF. J Am Coll Cardiol. 2015;65(10):A1020.

43. Ambrosy AP, Cerbin LP, Armstrong PW, Butler J, Coles A, DeVore AD, et al. Body Weight Change During and After Hospitalization for Acute Heart Failure: Patient Characteristics, Markers of Congestion, and Outcomes: Findings from the ASCEND-HF Trial. JACC Hear Fail. 2017;5(1):1–13.

Aronson D, Burger AJ. Diuretic Response: Clinical and Hemodynamic Predictors and Relation to Clinical Outcome. J Card Fail. 2016;22(3):193–200.

H. Verbrugge F, Dupont M, B. Bertrand P, Nijst P, Penders J, Dens J, et al. Determinants and impact of the natriuretic response to diuretic therapy in heart failure with reduced ejection fraction and volume overload. Acta Cardiol. 2015;70(3):265–73.

Damman K, Ter Maaten JM, Coster JE, Krikken JA, Deursen VM, Krijnen HK, et al. Clinical importance of urinary sodium excretion in acute heart failure. Eur J Heart Fail. 2020;1–10.

Singh D, Shrestha K, Testani JM, Verbrugge FH, Dupont M, Mullens W, et al. Insufficient natriuretic response to continuous intravenous furosemide is associated with poor long-term outcomes in acute decompensated heart failure. Jounal Card Fail. 2014;20(6):392–9.

Iqbal J, Javaid MM. Diuretic resistance and its management. Br J Hosp Med. 2014;75(7):103–7.

Cox ZL, Lenihan DJ. Loop Diuretic Resistance in Heart Failure: Resistance Etiology - Based Strategies to Restoring Diuretic Efficacy. J Card Fail. 2014;20(8):611–22.

Kumar D, Bagarhatta R. Fractional Excretion of Sodium and Its Association with Prognosis of Decompensated Heart Failure Patients. Jpurnal Clin Diagnostic Res. 2015;9(4):OC01–OC03.

Fonarow GC. The Acute Decompensated Heart Failure National Registry (ADHERETM): Opportunities to improve care of patients hospitalized with acute decompensated heart failure. Rev Cardiovasc Med. 2003;4(SUPPL. 7):21– 30.

52. Neuberg GW, Miller AB, O’Connor CM, Belkin RN, Carson PE, Cropp AB, et al. Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J. 2002;144(1):31–8.

Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation. 2010;122(3):265–72.

Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. N Engl J Med. 2011;364(9):797–805.

Dikshit K, Vyden JK, Forrester JS, Chatterjee K, Prakash R, Swan HJ. Renal and extrarenal hemodynamic effects of furosemide in congestive heart failure after acute myocardial infarction. N Engl J Med. 1973;288(21):1087–90.

Chan JSK, Kot TKM, NG M, Harky A. Continuous Infusion Versus Intermittent Boluses of Furosemide in Acute Heart Failure: A Systematic Review and Meta-Analysis. J Card Fail. 2020 Sep;26(9):786-793.

Brisco-Bacik MA, Ter Maaten JM, Houser SR, Vedage NA, Rao V, Ahmad T, et al. Outcomes associated with a strategy of adjuvant metolazone or high-dose loop diuretics in acute decompensated heart failure: A propensity analysis. J Am Heart Assoc. 2018;7(18):e009149.

Butler J, Anstrom KJ, Felker GM, Givertz MM, Kalogeropoulos AP, Konstam MA, et a. Efficacy and safety of spironolactone in acute heart failure: The ATHENA-HF randomized clinical trial. JAMA Cardiol. 2017;2(9):950–8.

Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure: The 3T Trial. JACC Hear Fail. 2020;8(3):157–68.

Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209–16.

Palazzuoli A, Testani JM, Ruocco G, Pellegrini M, Ronco C, Nuti R. Different diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance. Int J Cardiol. 2016;224:213–9.

Damman K, Valente MAE, Voors AA, O’Connor CM, Van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: An updated meta-analysis. Eur Heart J. 2014;35(7):455–69.

Metra M, Cotter G, Senger S, Edwards C, Cleland JG, Ponikowski P, et al. Prognostic Significance of Creatinine Increases During an Acute Heart Failure Admission in Patients With and Without Residual Congestion: A Post Hoc Analysis of the PROTECT Data. Circ Heart Fail. 2018;11(5):e004644.

Timoh T, Protano MA, Wagman G, Bloom M, Vittorio TJ. A perspective on cirrhotic cardiomyopathy. Transplant Proc. 2011;43(5):1649–53.

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