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CLINICAL RESEARCH: HEART FAILURE

Changes in Brain Natriuretic Peptide Levels and Bioelectrical Impedance Measurements After Treatment With High-Dose Furosemide and Hypertonic Saline Solution Versus High-Dose Furosemide Alone in Refractory Congestive Heart Failure

A Double-Blind Study

Salvatore Paterna, MD^_*, Pietro Di Pasquale, MD^||,_*, Gaspare Parrinello, MD, Ersilia Fornaciari, MD^_*, Francesca Di Gaudio, MD, Sergio Fasullo, MD^||, Marco Giammanco, MD, Filippo M. Sarullo, MD^¶ and Giuseppe Licata, MD

^_* Department of Emergency Medicine, University of Palermo, Palermo, Italy
Department of Internal Medicine, University of Palermo, Palermo, Italy
Department of Medical Biotechnology and Legal Medicine, Chemistry Group, and Medical Biochemistry, University of Palermo, Palermo, Italy
Institute of Physiology, University of Palermo, Palermo, Italy
^|| Division of Cardiology "Paolo Borsellino," G. F. Ingrassia Hospital, Palermo, Italy
^¶ Buccheri La Ferla Hospital, Palermo, Italy.

Manuscript received November 28, 2004; revised manuscript received January 6, 2005, accepted January 26, 2005.

^_* Reprint requests and correspondence: Dr. Pietro Di Pasquale, Division of Cardiology, "Paolo Borsellino," Via Val Platani 3, 90144, Palermo, Italy. (Email: lehdi{at}tin.it).

OBJECTIVES: The aim of this study was to evaluate the effect of a new treatment for refractory congestive heart failure (CHF) on brain natriuretic peptide (BNP) plasma levels and hydration station.

BACKGROUND: The study was aimed at evaluating the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) in refractory CHF patients.

METHODS: A total of 94 patients (34 women/60 men) with refractory CHF (age 55 to 80 years) were enrolled. They had to have an ejection fraction <35%, serum creatinine <2 mg/dl, blood urea nitrogen <60 mg/dl, a reduced urinary volume, and a low natriuresis (<500 ml/24 h and <60 mEq/24 h, respectively). Patients were divided (double-blind) into two groups: group 1 (18 women/30 men) received an intravenous furosemide (500 to 1,000 mg) plus HSS twice a day in 30 min. Group 2 (16 women/30 men) received an intravenous bolus of furosemide (500 to 1,000 mg/twice a day) alone, for four to six days. At entry, body weight, blood pressure, heart rate, and laboratory parameters were checked during hospitalization; BNP levels were measured on admission, 6 and 30 days after discharge, while on admission and 6 days after, impedance plethysmography was performed. The HSS group received 120 mmol of Na intake versus 80 mmol in non-HSS group. Fluid intake of 1,000 was given to both groups.

RESULTS: The groups were similar for clinical characteristics. A significant increase in daily diuresis and natriuresis was observed in HSS group, p < 0.05. The BNP values showed significant intragroup and intergroup differences, 6 and 30 days after treatment. The patients from the HSS group reached a better hydration state than the non-HSS group after six days. In addition, the HSS group showed a significant reduction in hospitalization time and readmission rate.

CONCLUSIONS: Our data show that the HSS group reached dry weight more rapidly, a significantly faster reduction in BNP levels, shorter hospitalization stay, and lower incidence in readmissions in the 30-day study period.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   BIA = bioelectrical impedance analysis   BNP = brain natriuretic peptide   BW = body weight   CHF = congestive heart failure   HSS = hypertonic saline solution   NYHA = New York Heart Association

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