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Online Quantitative Aortographic Assessment of Aortic Regurgitation After TAVR: Results of the OVAL Study Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes Relation between baseline plaque features and subsequent coronary artery remodeling determined by optical coherence tomography and intravascular ultrasound Stage-dependent differential effects of interleukin-1 isoforms on experimental atherosclerosis Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure) Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial

Review ArticleVolume 75, Issue 10, March 2020

JOURNAL:J Am Coll Cardiol. Article Link

Diuretic Therapy for Patients With Heart Failure JACC State-of-the-Art Review

GM Felker, DH Ellison, W Mullens et al. Keywords: congestion; diuretics; heart failure; pharmacology

ABSTRACT

Expansion of extracellular fluid volume is central to the pathophysiology of heart failure. Increased extracellular fluid leads to elevated intracardiac filling pressures, resulting in a constellation of signs and symptoms of heart failure referred to as congestion. Loop diuretics are one of the cornerstones of treatments for heart failure, but in contrast to other therapies, robust clinical trial evidence to guide the use of diuretics is sparse. A nuanced understanding of renal physiology and diuretic pharmacokinetics is essential for skillful use of diuretics in the management of heart failure in both the inpatient and outpatient settings. Diuretic resistance, defined as an inadequate quantity of natriuresis despite an adequate diuretic regimen, is a major clinical challenge that generally portends a poor prognosis. In this review, the authors discuss the fundamental mechanisms and physiological principles that underlie the use of diuretic therapy and the available data on the optimal use of diuretics.