Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial

Aims Diuretic resistance (DR) in acute decompensated heart failure (ADHF) is associated with poor outcomes. The CLOROTIC trial demonstrated hydrochlorothiazide (HCTZ) with intravenous furosemide improved weight loss in ADHF. We assessed performance of the BAN-ADHF DR score and association between DR...

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Autores: Pandey, Ambarish, Segar, Matthew W., Keshvani, Neil, Llácer, Pau, Casado, Jesús, Morales Rull, José Luis, Formiga, Francesc, Manzano, Luis, Van Spall, Harriette G.C., Trullàs, Joan Carles
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Universitat de Lleida (UdL)
Repositorio:Repositori Obert UdL
OAI Identifier:oai:repositori.udl.cat:10459.1/468723
Acceso en línea:https://doi.org/10.1002/ejhf.70002
https://hdl.handle.net/10459.1/468723
Access Level:acceso abierto
Palabra clave:Acute heart failure
Diuretic resistance
Thiazide
Decongestion
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spelling Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trialPandey, AmbarishSegar, Matthew W.Keshvani, NeilLlácer, PauCasado, JesúsMorales Rull, José LuisFormiga, FrancescManzano, LuisVan Spall, Harriette G.C.Trullàs, Joan CarlesAcute heart failureDiuretic resistanceThiazideDecongestionAims Diuretic resistance (DR) in acute decompensated heart failure (ADHF) is associated with poor outcomes. The CLOROTIC trial demonstrated hydrochlorothiazide (HCTZ) with intravenous furosemide improved weight loss in ADHF. We assessed performance of the BAN-ADHF DR score and association between DR risk and HCTZ treatment response. Methods and results We included participants from CLOROTIC and assessed BAN-ADHF performance in identifying lowest net diuretic efficiency phenogroup, as identified with a random forest classifier. Participants were stratified by the BAN-ADHF score (≤12: low DR risk and >12: high DR risk) to compare treatment effect of HCTZ versus placebo across DR risk. Outcomes were weight change and area under the curve (AUC) of dyspnoea visual analogue scale (VAS) at 72/96 h, fluid loss at 72 h, and 30/90-day mortality. Among 220 participants (50.9% male, mean age 83 years), the BAN-ADHF score demonstrated good performance in identifying low net diuretic efficiency phenogroup (area under the receiver operating characteristic curve: 0.81). Weight change and VAS AUC at 72 h was similar across DR risk strata, however, participants with high versus low DR risk had lower fluid loss at 72 h (686 vs. 889 ml, p = 0.003), higher 30-day (11.1% vs. 2.4%, p = 0.035) and 90-day mortality (23.0% vs. 10.6%, p = 0.033). The treatment effect of HCTZ (vs. placebo) on weight change was similar across DR risk (pint = 0.75 at 72 h; pint = 0.50 at 96 h). DR risk modified efficacy of HCTZ versus placebo on dyspnoea VAS, with high (vs. low) DR risk having attenuated improvement at 72 h (−236 vs. 476 mm; pint = 0.03) and 96 h (−400 vs. 777 mm; pint = 0.001). Conclusions The BAN-ADHF score demonstrated good performance in identifying DR, and high DR risk was associated with worse outcomes. HCTZ treatment response on weight loss was similar across DR risk, but improvement in dyspnoea with HCTZ was attenuated in high DR risk.John Wiley & Sons2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://doi.org/10.1002/ejhf.70002https://hdl.handle.net/10459.1/468723reponame:Repositori Obert UdL instname:Universitat de Lleida (UdL)InglésReproducció del document publicat a: https://doi.org/10.1002/ejhf.70002European Journal of Heart Failure, 2025, [online ahead of print]cc-by, (c) Ambarish Pandey et al., 2025Attribution 4.0 Internationalinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by/4.0/oai:repositori.udl.cat:10459.1/4687232026-06-24T12:42:17Z
dc.title.none.fl_str_mv Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
title Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
spellingShingle Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
Pandey, Ambarish
Acute heart failure
Diuretic resistance
Thiazide
Decongestion
title_short Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
title_full Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
title_fullStr Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
title_full_unstemmed Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
title_sort Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post-hoc analysis of the CLOROTIC trial
dc.creator.none.fl_str_mv Pandey, Ambarish
Segar, Matthew W.
Keshvani, Neil
Llácer, Pau
Casado, Jesús
Morales Rull, José Luis
Formiga, Francesc
Manzano, Luis
Van Spall, Harriette G.C.
Trullàs, Joan Carles
author Pandey, Ambarish
author_facet Pandey, Ambarish
Segar, Matthew W.
Keshvani, Neil
Llácer, Pau
Casado, Jesús
Morales Rull, José Luis
Formiga, Francesc
Manzano, Luis
Van Spall, Harriette G.C.
Trullàs, Joan Carles
author_role author
author2 Segar, Matthew W.
Keshvani, Neil
Llácer, Pau
Casado, Jesús
Morales Rull, José Luis
Formiga, Francesc
Manzano, Luis
Van Spall, Harriette G.C.
Trullàs, Joan Carles
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Acute heart failure
Diuretic resistance
Thiazide
Decongestion
topic Acute heart failure
Diuretic resistance
Thiazide
Decongestion
description Aims Diuretic resistance (DR) in acute decompensated heart failure (ADHF) is associated with poor outcomes. The CLOROTIC trial demonstrated hydrochlorothiazide (HCTZ) with intravenous furosemide improved weight loss in ADHF. We assessed performance of the BAN-ADHF DR score and association between DR risk and HCTZ treatment response. Methods and results We included participants from CLOROTIC and assessed BAN-ADHF performance in identifying lowest net diuretic efficiency phenogroup, as identified with a random forest classifier. Participants were stratified by the BAN-ADHF score (≤12: low DR risk and >12: high DR risk) to compare treatment effect of HCTZ versus placebo across DR risk. Outcomes were weight change and area under the curve (AUC) of dyspnoea visual analogue scale (VAS) at 72/96 h, fluid loss at 72 h, and 30/90-day mortality. Among 220 participants (50.9% male, mean age 83 years), the BAN-ADHF score demonstrated good performance in identifying low net diuretic efficiency phenogroup (area under the receiver operating characteristic curve: 0.81). Weight change and VAS AUC at 72 h was similar across DR risk strata, however, participants with high versus low DR risk had lower fluid loss at 72 h (686 vs. 889 ml, p = 0.003), higher 30-day (11.1% vs. 2.4%, p = 0.035) and 90-day mortality (23.0% vs. 10.6%, p = 0.033). The treatment effect of HCTZ (vs. placebo) on weight change was similar across DR risk (pint = 0.75 at 72 h; pint = 0.50 at 96 h). DR risk modified efficacy of HCTZ versus placebo on dyspnoea VAS, with high (vs. low) DR risk having attenuated improvement at 72 h (−236 vs. 476 mm; pint = 0.03) and 96 h (−400 vs. 777 mm; pint = 0.001). Conclusions The BAN-ADHF score demonstrated good performance in identifying DR, and high DR risk was associated with worse outcomes. HCTZ treatment response on weight loss was similar across DR risk, but improvement in dyspnoea with HCTZ was attenuated in high DR risk.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://doi.org/10.1002/ejhf.70002
https://hdl.handle.net/10459.1/468723
url https://doi.org/10.1002/ejhf.70002
https://hdl.handle.net/10459.1/468723
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1002/ejhf.70002
European Journal of Heart Failure, 2025, [online ahead of print]
dc.rights.none.fl_str_mv cc-by, (c) Ambarish Pandey et al., 2025
Attribution 4.0 International
info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by/4.0/
rights_invalid_str_mv cc-by, (c) Ambarish Pandey et al., 2025
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv John Wiley & Sons
publisher.none.fl_str_mv John Wiley & Sons
dc.source.none.fl_str_mv reponame:Repositori Obert UdL
instname:Universitat de Lleida (UdL)
instname_str Universitat de Lleida (UdL)
reponame_str Repositori Obert UdL
collection Repositori Obert UdL
repository.name.fl_str_mv
repository.mail.fl_str_mv
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