Background:Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization.Methods:Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0–9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST.Results:Median UNa after FST in the 65 patients included was 113 (97–122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa; P=0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa; P<0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months.Conclusions:Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.

中文翻译：

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急性心力衰竭期间速尿压力试验的利尿钠反应的潜在作用

背景：尿钠排泄不良与利尿剂治疗反应较差和急性心力衰竭预后较差有关。缺乏关于如何以及何时测量尿钠 (UNa) 的建议。我们的目标是评估呋塞米压力测试 (FST) 后的 UNa 量化，以预测急性心力衰竭住院期间的适当缓解充血。方法：患者在入院第 1 天接受 FST，2 小时后测量 UNa，将患者分为低或基于样本中值的高 UNa。在 FST 前和 FST 后第 5 天评估半定量综合充血评分（CCS；0-9）和 NT pro-BNP（N 端前 B 型利钠肽）定量。结果：在 FST 后的中位数 UNa纳入的 65 名患者为 113 (97-122) mmol/L。第 5 天，P = 0.005）和适当的去充血等级（CCS<3）（低 UNa 为 20 [62%]，高 UNa 为 32 [97%]；P <0.001）。FST 后 2 小时 UNa>83 mmol/L 预测 NT-proBNP 减少 ≥30% 的敏感性为 96%，预测第 5 天 CCS<3 的敏感性为 95%。低 UNa 患者的累积利尿和体重减轻较低并且更常出现住院时间延长、心力衰竭恶化以及在 6 个月时因急性心力衰竭或死亡而再次入院。结论：FST 后的低尿钠排泄确定了利尿剂反应不足和不适当减充血的风险较高的患者。FST 指导的利尿剂治疗可能有助于改善充血、缩短住院时间并减少不良后果。