title: Changes in estimating echocardiography pulmonary capillary wedge pressure after hypersaline plus furosemide versus furosemide alone in decompensated heart failure.
abstract: BACKGROUND
  The aim of the study was to verify the effects of hypertonic saline solution (HSS) plus a high furosemide dose and light restriction of sodium intake compared with a high-dose infusion of furosemide alone on pulmonary capillary wedge pressure (PCWP), as determined by Doppler echocardiography and tissue Doppler imaging in patients suffering from decompensated heart failure.
  
  
  RESULTS
  Consecutive patients in New York Heart Association functional class IV, unresponsive to oral high doses of furosemide up to 250-500 mg/d and/or combinations of diuretics, with ejection fraction <40%, serum creatinine <2 mg/dL, blood urea nitrogen ≤60 mg/dL, reduced urinary volume (<500 mL/24 h), and low natriuresis (<60 mEq/24 h) were randomized into 2 groups (double blind). The first group received a furosemide infusion (250 mg) plus HSS (150 mL 3.0% Na) bid and light Na restriction (120 mmol), and the second group received furosemide infusion (250 mg) twice daily, and low Na diet (80 mmol). The fluid intake of both groups was restricted (1 L/d). Body weight, whole-body bioelectrical impedance analysis (BIA), 24-hour urinary volume, and serum and urinary laboratory parameters were measured daily. Estimations of echocardiographic PCWP (Echo-PCWP) were detected on entry, 1 hour after concluding the initial treatment, and 6 days thereafter. A total of 133 patients (47 women and 86 men), aged 65-82 years, met the entry criteria.The HSS group revealed a significant increase in daily diuresis, natriuresis, and serum sodium compared with the furosemide group. Six days after treatment, renal function was significantly improved in the HSS group. Both groups showed a significant reduction in Echo-PCWP, but the HHS group revealed a faster reduction and significant lower values at 6 days compared with the group taking furosemide alone. We observed a positive correlation between values of Echo-PCWP and BNP and an inverse correlation between BIA parameters and Echo-PCWP.
  
  
  CONCLUSIONS
  Our data show that the combination of high diuretic dose and HSS infusion plus light restriction in dietary sodium intake determine a more rapid and significant hemodynamic stabilization through the improvement of echo-PCWP, BNP levels, and BIA parameters than the group treated without HSS.
authors: Biomedical Department of Internal and Specialty Medicine, University of Palermo, Piazza delle Cliniche 2, Palermo, Italy. gaspare.parrinello@unipa.it
authors: Gaspare
authors: G
authors: Parrinello
authors: Salvatore
authors: S
authors: Paterna
authors: Pietro
authors: P
authors: Di Pasquale
authors: Daniele
authors: D
authors: Torres
authors: Manuela
authors: M
authors: Mezzero
authors: Mauro
authors: M
authors: Cardillo
authors: Sergio
authors: S
authors: Fasullo
authors: Gabriella
authors: G
authors: La Rocca
authors: Giuseppe
authors: G
authors: Licata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000494:pharmacology* / Q000627:therapeutic use; D004311:Double-Blind Method; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005665:Furosemide / Q000494:pharmacology* / Q000627:therapeutic use; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010992:Plethysmography, Impedance; D011669:Pulmonary Wedge Pressure / Q000187:drug effects*; D012462:Saline Solution, Hypertonic / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D012462:Saline Solution, Hypertonic; D005665:Furosemide