Discover and read the best of Twitter Threads about #ADVOR

Most recents (10)

Read our latest analysis from the #ADVOR trial @JACCJournals. Deeper dive into the relationship of #natriuresis with decongestion & clinical outcomes after diuretic therapy in acute #heartfailure! Tweetorial below...…

@PieterMartensMD @WilfriedMullens
First, look at detailed #ADVOR protocol below:…

We did 2 consecutive urine collections:
1. Randomization => First morning (<24 h)
2. First morning => Second morning (=24 h)

If in those 2 collections, cumulative urine output <3.5 L ➡️ Failed decongestion! Image
Allocation to #acetazolamide clearly increased:
✅total urine output (+12.6%)
✅total natriuresis (+26.9%)

In relative terms: effect on natriuresis > urine output, UO🚫significant after 1st diuretic dose, natriuresis remained high!

*Normalized UO to 24 h for collection 1. Image
Read 20 tweets
Really proud moment for me today, presenting 1st time in a Featured Science session @AHAScience.

Deeper insight in #ADVOR trial with key contributions from @WilfriedMullens @PieterMartensMD @JeroenDauw @petra_nijst @EvelyneMeekers among many others. Proudly 🇧🇪!
Tweetorial below!
From #ADVOR population, we included 462 or 89% of patients with 2 correctly performed consecutive urine collections and urine sodium concentration (UNa) available.

- UNa [mmol/L] ~ diuretic efficiency
- Total natriuresis [mmol] ~ ECV & interstitial Na buffer removed
#Acetazolamide, after multivariate adjustment, was strongest predictor of #natriuresis in #ADVOR:
UNa + 16 mmol/L
Total natriuresis +115 mmol

👊 within 2 days !!!
👍 much stronger than effect on urine output itself

"#acetazolamide keeps the urine salted"
Read 9 tweets
Breaking News @AHAScience with #TRANSFORMHF - the largest (N=2859) ambulatory #heartfailure diuretic trial to determine if torsemide would be superior to furosemide to ⬇️ reduce all-cause mortality - what a huge accomplishment of @robmentz et al!!! (1/9)…
At first sight 'no need to transform your practice' as both are similarly effective for mortality (2/9)
Also similar for mortality and all-cause hospitalizations (3/9)
Read 9 tweets
Follow this #CardioTwitter #Thread
to get an overview of ALL
🚨#ESCcongress #HotLineSessions🚨

➡️14 #OnePager #CongressCards
➡️Links to on-demand stream
➡️Jorunal weblinks
➡️Hashtag of the author/presenter

PART 1 ⬇️
On-demand ESC 📺:

1.1./ #TIME trial - The Treatment in Morning versus Evening study.

On-demand ESC 📺:

Read 25 tweets
For those who can't get enough from #ADVOR, below the promised Tweetorial!

Acetazolamide in acute #HeartFailure w volume overload on background high-dose loop diuretics:
👍Increases diuresis & natriuresis
👍More euvolemia after 3 days & discharge
#ESCCongress #Cardiology
First, the unsung hero's of this trial, done with a little bit over 2 million €, bargain for largest diuretic #RCT ever!
@KatrienTartagl2 & her team, with only 3FTE, they ran the most successful trial in #AHF
@PieterMartensMD & @JeroenDauw who did most fieldwork
How did we come up with the idea? Actually, cause we all love #physiology. Credits go to Prof. Em. Paul Steels who teached us all how kidneys work.

65% of sodium is reabsorbed in the proximal tubules, can be up to 85% in #HeartFailure
Read 12 tweets
Results of the randomized #ADVOR trial are soon coming your way! It's the largest diuretic trial in acute #heartfailure ever conducted (N=519) and will test acetazolamide on top of loop diuretics. Recruitment is finished and full database lock is anticipated. Find out more (1/9). Image
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines (2/9).…
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC Image
Only 15% of AHF included in DOSE trial were decongested after 72 hours of high-dose loop diuretic (LD) therapy (3/9).… Image
Read 9 tweets
What to do if the eGFR drops from 50 to 42 ml/min/m2 during decongestive therapy in acute #HeartFailure ?
Short #Tweetorial on worsening renal function (WRF) (1/9).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC
There is an underappreciated risk of poor outcome in heart failure patients discharged with ongoing congestion and WRF (2/9).
Pivotal paper of @MarcoMetra…
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines so DON'T stop decongestive efforts during WRF (3/9).…
Read 9 tweets
Which statement is correct with regards to the use of diuretics in #HeartFailure with congestion?

Short #Tweetorial on how to use diuretics in heart failure (1/9).

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC
Door to ‘diuretic’ time: earlier administration of loop diuretics is associated with improved outcomes independent of HF severity (2/9).…
The first dose of the loop diuretic should be 40 mg furosemide (=1 mg bumetanide) in diuretic naïve and twice the home dose in patients on loop diuretic (3/9).
Read 9 tweets
1/10. Wat is the most important driver of worsening renal function in #HeartFailure ?

Look at #Tweetorial on central hemodynamic derangements in heart failure

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR
2/10. The kidney is a remarkable vascular organ. Renal blood flow = 1000 ml/min, renal plasma flow = 600 ml/min.
3/10. Elevated central venous pressure affects renal function significantly more than reduced cardiac output in heart failure.…
Read 10 tweets
Tweet: renal sodium avidity in #HeartFailure

Do you ever wonder what is happening in the kidney in Heart Failure patients? Here’s a short #Tweetorial on renal physiology in HF (1/6).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR
Glomerulus: renal blood flow ↓ in HF, but the kidney tries to maintain GFR by afferent arteriolar vasodilation and efferent arteriolar vasoconstriction. This leads to single-nephron hyperfiltration initially preserving total GFR, but further damaging the glomerulus. (2/6)
Proximal tubules: hyperfiltration leads to ↑ water and solutes filtered, but ↓ remaining in the peritubular capillaries. Due to ↑ peritubular capillary oncotic pressure + ↑ renal lymph flow -> ↑ water and Na+ reabsorption in the proximal tubules (3/6)
Read 6 tweets

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