Decongestion With Acetazolamide in Acute Decompensated Heart Failure Across the Spectrum of Left Ventricular Ejection Fraction: A Prespecified Analysis From the ADVOR Trial

• DOI: 10.1161/circulationaha.122.062486
• Publication Date: 2022-11-06T14:18:08Z
• Authors: Pieter Martens; Jeroen Dauw; Frederik H. Verbr...; Petra Nijst; Evelyne Meekers; Silvio Nunes Augusto; Jozine M. Ter Maaten; Kevin Damman; Alexandre Mebazaa; Gerasimos Filippatos; Frank Ruschitzka; W.H. Wilson Tang; Matthias Dupont; Wilfried Mullens
• Keywords: Acetazolamide

Background: Acetazolamide inhibits proximal tubular sodium reabsorption and improved decongestion in the ADVOR (Acetazolamide Decompensated Heart Failure with Volume Overload) trial. It remains unclear whether decongestive effects of acetazolamide differ across spectrum left ventricular ejection fraction (LVEF). Methods: This is a prespecified analysis randomized, double-blind, placebo-controlled trial that enrolled 519 patients acute heart failure (HF), clinical signs volume overload (eg, edema, pleural effusion, or ascites), NTproBNP (N-terminal pro-B-type natriuretic peptide) >1000 ng/L, BNP (B-type >250 ng/mL to receive intravenous (500 mg once daily) placebo addition standardized loop diuretics (twice oral home maintenance dose). Randomization was stratified according LVEF (≤40% >40%). The primary end point successful decongestion, defined as absence within 3 days from randomization without need for mandatory escalation therapy because poor urine output. Results: Median 45% (25th 75th percentile; 30% 55%), 43% had an ≤40%. Patients lower were younger more likely be male higher prevalence ischemic disease, NTproBNP, less atrial fibrillation, estimated glomerular filtration rate. No interaction on overall beneficial treatment effect (OR, 1.77 [95% CI, 1.18-2.63]; P =0.005; all values >0.401) found when assessed per stratum >40%), HF reduced fraction, mildly preserved continuous scale. resulted diuretic response measured by cumulative diuresis natriuresis shortened length stay modification baseline (all >0.160). Conclusions: When added decompensated HF, improves incidence response, shortens LVEF. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03505788.