title: Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur).
abstract: BACKGROUND
  High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF.
  
  
  METHODS
  A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or B. Plasma levels of cardiac troponin-I, brain natriuretic peptide, glomerular filtration rate by Modification of Diet in Renal Disease formula, bioelectrical impedance analysis measurements, and delta pressure/delta time (dP/dt) rate were observed on admission and discharge for all patients.
  
  
  RESULTS
  We observed a significant reduction of cardiac troponin in both groups and a significant improvement in renal function, hydration state, pulmonary capillary wedge pressure (P < .0001), end diastolic volume (P < .01), ejection fraction (P < .01), and dP/dt (P < .004) in group A. We also observed a significant reduction in body weight (64.4 vs 75.8 kg) (P < .001), cardiac troponin I (0.02 vs 0.31 ng/mL) (P < .0001) and brain natriuretic peptide (542 vs 1,284 pg/mL) (P < .0001), and hospitalization time (6.25 vs 10.2 days) (P < .0001) in the HSS group.
  
  
  CONCLUSIONS
  These data demonstrate that intravenous high doses of furosemide do not increase myocardial injury and, in addition, when associated to HSS, significantly reduce cardiac troponin I release. This behavior is mirrored by the achievement of improved hemodynamic compensation at echocardiography and body hydration normalization.
authors.affiliation: Department of Internal and Specialty Medicine, Chair of Clinical Pathophysiology, University of Palermo, Italy. gaspare.parrinello@unipa.it
authors.forename: Gaspare
authors.initials: G
authors.lastname: Parrinello
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pasquale
authors.forename: Daniele
authors.initials: D
authors.lastname: Torres
authors.forename: Mauro
authors.initials: M
authors.lastname: Cardillo
authors.forename: Caterina
authors.initials: C
authors.lastname: Schimmenti
authors.forename: Umberto
authors.initials: U
authors.lastname: Lupo
authors.forename: Rossella
authors.initials: R
authors.lastname: Iatrino
authors.forename: Rossella
authors.initials: R
authors.lastname: Petrantoni
authors.forename: Carla
authors.initials: C
authors.lastname: Montaina
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giambanco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paterna
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D018618:Echocardiography, Doppler, Color; D017097:Electric Impedance; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D011188:Potassium / Q000097:blood; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D019210:Troponin I / Q000097:blood* / Q000187:drug effects
chemical_list: D004232:Diuretics; D012462:Saline Solution, Hypertonic; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D005665:Furosemide; D011188:Potassium