{
    "abstract": "The prognostic value of 'high dose' loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT).\nAll ambulatory patients (n\u00a0=\u00a0700, median age 55\u00a0years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into 'low dose', 'intermediate dose', and 'high dose' loop diuretics corresponding to furosemide equivalent doses of \u226440, 40-250, and >250\u00a0mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N-terminal pro-B-type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12\u00a0months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P\u00a0=\u00a00.001) for 'low dose', 'intermediate dose', and 'high dose' patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the 'high dose' group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P\u00a0=\u00a00.002] and a six-fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P\u00a0<\u00a00.001) when compared with the 'low dose' group. 'Intermediate doses' were not significantly associated with these two outcomes in adjusted models (P\u00a0>\u00a00.05).\nA 'high dose' of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre-HT patients.",
    "authors": [
        {
            "affiliation": "Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Reicatra, Vandoeuvre-l\u00e8s-Nancy, 54500, France.",
            "firstname": "Guillaume",
            "initials": "G",
            "lastname": "Baudry"
        },
        {
            "affiliation": "Department of Cardiac and Thoracic Surgery, Cardiology Institute, Piti\u00e9 Salp\u00eatri\u00e8re Hospital, Assistance Publique-H\u00f4pitaux de Paris (AP-HP). Sorbonne University Medical School, Paris, France.",
            "firstname": "Guillaume",
            "initials": "G",
            "lastname": "Coutance"
        },
        {
            "affiliation": "Department of Cardiac Surgery, CHU Bichat-Claude Bernard, AP-HP, Universit\u00e9 Paris VII, Paris, France.",
            "firstname": "Richard",
            "initials": "R",
            "lastname": "Dorent"
        },
        {
            "affiliation": "Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France.",
            "firstname": "Fabrice",
            "initials": "F",
            "lastname": "Bauer"
        },
        {
            "affiliation": "Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France.",
            "firstname": "Katrien",
            "initials": "K",
            "lastname": "Blanchart"
        },
        {
            "affiliation": "Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France.",
            "firstname": "Aude",
            "initials": "A",
            "lastname": "Boignard"
        },
        {
            "affiliation": "Department of Thoracic and Cardiovascular Surgery, CHU Pontchaillou, Inserm U1099, Rennes, France.",
            "firstname": "C\u00e9line",
            "initials": "C",
            "lastname": "Chabanne"
        },
        {
            "affiliation": "Department of Cardiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.",
            "firstname": "Cl\u00e9ment",
            "initials": "C",
            "lastname": "Delmas"
        },
        {
            "affiliation": "Department of Cardiology and Cardiac Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.",
            "firstname": "Nicolas",
            "initials": "N",
            "lastname": "D'Ostrevy"
        },
        {
            "affiliation": "Department of Cardiology and Cardiovascular Surgery, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France.",
            "firstname": "Eric",
            "initials": "E",
            "lastname": "Epailly"
        },
        {
            "affiliation": "Department of Cardiac Surgery, La Timone Hospital, Marseille, France.",
            "firstname": "Vlad",
            "initials": "V",
            "lastname": "Gariboldi"
        },
        {
            "affiliation": "Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France.",
            "firstname": "Philippe",
            "initials": "P",
            "lastname": "Gaudard"
        },
        {
            "affiliation": "Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France.",
            "firstname": "C\u00e9line",
            "initials": "C",
            "lastname": "Go\u00e9minne"
        },
        {
            "affiliation": "Department of Cardiology and Cardiac Surgery, Dijon University Hospital, Dijon, France.",
            "firstname": "Sandrine",
            "initials": "S",
            "lastname": "Grosjean"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, Marie Lannelongue Hospital, University of Paris Sud, Inserm U999 (Pulmonary Hypertension: Pathophysiology and Novel Therapies [PAH]), Le Plessis Robinson, France.",
            "firstname": "Julien",
            "initials": "J",
            "lastname": "Guihaire"
        },
        {
            "affiliation": "Department of Cardiology and Cardiac Surgery, European Georges Pompidou Hospital, Paris, France.",
            "firstname": "Romain",
            "initials": "R",
            "lastname": "Guillemain"
        },
        {
            "affiliation": "Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France.",
            "firstname": "Mathieu",
            "initials": "M",
            "lastname": "Mattei"
        },
        {
            "affiliation": "Department of Thoracic and Cardiovascular Surgery, H\u00f4pital Cardiologique du Haut-L\u00e9v\u00eaque, Universit\u00e9 Bordeaux II, Bordeaux, France.",
            "firstname": "Karine",
            "initials": "K",
            "lastname": "Nubret"
        },
        {
            "affiliation": "Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France.",
            "firstname": "Sabine",
            "initials": "S",
            "lastname": "Pattier"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, Tours University Hospital, Tours, France.",
            "firstname": "Emmanuelle",
            "initials": "E",
            "lastname": "Vermes"
        },
        {
            "affiliation": "Department of Heart Failure and Transplantation, H\u00f4pital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Bron, France.",
            "firstname": "Laurent",
            "initials": "L",
            "lastname": "Sebbag"
        },
        {
            "affiliation": "Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Reicatra, Vandoeuvre-l\u00e8s-Nancy, 54500, France.",
            "firstname": "Kevin",
            "initials": "K",
            "lastname": "Duarte"
        },
        {
            "affiliation": "Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433, INSERM DCAC, CHRU de Nancy, F-CRIN INI-CRCT, Reicatra, Vandoeuvre-l\u00e8s-Nancy, 54500, France.",
            "firstname": "Nicolas",
            "initials": "N",
            "lastname": "Girerd"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",
    "doi": "10.1002/ehf2.14467",
    "journal": "ESC heart failure",
    "keywords": [
        "Advanced heart failure",
        "Cardiorenal syndrome",
        "Congestion",
        "Diuretic",
        "Heart transplant"
    ],
    "methods": null,
    "publication_date": "2023-07-06",
    "pubmed_id": "37408178\n34447992\n29806100\n28258792\n25560378\n33956209\n16534009\n8813041\n16765130\n28272288\n26858290\n17706809\n16709595\n12932605\n23758444\n26693947\n30600580\n32954072\n21029871\n36423214\n36027559\n31838029\n25619549\n32829662\n27819111\n33665512\n25599331\n26869641\n33085785\n30354446\n26417699\n29226815\n33118672\n21315441",
    "results": null,
    "title": "Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation.",
    "xml": "<Element 'PubmedArticle' at 0x7885048ca480>"
}