Diuretic resistance in acute decompensated HFpEF vs. HFrEF

Abstract

Abstract Background: Diuretic resistance (DR) is a common cause of inadequate decongestion in patients hospitalized with acute decompensated heart failure (ADHF). DR has not been characterized in patients with HF with preserved ejection fraction (HFpEF). Methods: In a post-hoc analysis of a pilot study evaluating the role of high-dose spironolactone in ADHF patients with DR, we analyzed the prevalence and potential pathophysiologic factors of DR in HFpEF (n=20) and compared those with HF with reduced EF (HFrEF) (n=27). DR was defined as weight loss<1lb/day despite intravenous furosemide>160mg/day (at least one dose of 80mg/day). Results: DR was observed in 10 (50%) of HFpEF participants as compared to 10 (37%) of HFrEF participants (p=ns). DR-HFpEF participants were older and had lower kidney function compared to DR-HFrEF. There was no difference in clinical presentation and lab parameters. Moreover, urine sodium/potassium ratio, plasma renin activity, plasma aldosterone and epinephrine levels were lower in DR-HFpEF as compared to DR-HFrEF, though still higher than diuretic responsive-HFpEF patients. Weight loss in response to high-dose spironolactone was similar in DR-HFpEF and HFrEF. Conclusion: We demonstrate that DR is more prevalent in HFpEF compared to HFrEF patients. Despite similar clinical features of congestion and response to high-dose spironolactone, a state of reduced neurohormonal activation points that additional factors might be contributing to DR in HFpEF versus HFrEF patients.