Reviewing current evidence on #hyponatremia in #heartfailure together with our bright visiting fellow @GiulioMonde!

Tweetorial 👇

link.springer.com/article/10.100… #hyponatremia in #heartfailure 🟰 mainly dilutional: ➡️Impaired water excretion & extracellular volume expansion!

However, we tend to underestimate the depletional component due to chronic potassium and magnesium losses
➡️Intracellular dehydration
➡️Intracellular sodium shift

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...

authors.elsevier.com/a/1h4wr2d9GHwT…

@PieterMartensMD @WilfriedMullens First, look at detailed #ADVOR protocol below:
onlinelibrary.wiley.com/doi/full/10.10…

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!

Teaming up again with the great @VerwerftJan to share our experience with #echoCPET in #HFpEF. This hot-of-the-press paper @ESC_Journals demonstrates myriad of opportunities for diagnosis & treatment, far beyond #SGLT2i only. Tweetorial below!

@SarahStroobant2 @HerbotsLieven We have recently described our set-up for a dedicated #dyspnoeaclinic in detail @JACCJournals

https://twitter.com/FH_Verbrugge/status/1622711913909026828

In #HFpEF, early & correct diagnosis are important, #phenotyping is everything. There are a lot of mechanisms for dyspnoea involved

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.

Natriuresis:
- UNa [mmol/L] ~ diuretic efficiency
- Total natriuresis [mmol] ~ ECV & interstitial Na buffer removed

What is your take on #vasodilators in acute #HeartFailure? The upcoming November issue of #EHJACVC will bring you a PRO/CON "Vasodilator therapy in acute heart failure revisited"

As our PRO paper was published in advanced access, a sneak preview Tweetorial below...

@EHJACVCEiC First some background...
Current @escardio guidelines state (IIb, B): "In patients with AHF and a systolic blood pressure (SBP) >110 mmHg, intravenous vasodilators may be considered as an initial therapy to improve symptoms and reduce congestion."
Only 1 flowchart has them in...

Don't miss our monthly educational review #EHJACVC @ESC_Journals!

This month by the great @ArgaizR: fluids in #AKI
Co-starring: @ThinkingCC @khaycock2

Extremely proud that our journal offers a platform to 3 great clinicians & Twitter educators. I always learn from them... A strong argument is made to switch mainstream thinking in #AKI away from the fallacious concept of fluid responsiveness in all to a primary assessment of fluid tolerance.

Probably the most important thing I have learned on Twitter: #VExUS

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
👍⬇️LOS
#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
👏

Do You keep slamming Your face because You missed the 1st #HFA @escardio Clinical Practice Update Course on #HeartFailure, orchestrated masterfully by MC Mullens?

Are You particularly disappointed to have missed the clinical pearls of #HFA giants @kevin_damman & @FinnGustafsson? Catch up for 2 months on the platform on demand: escardio.org/Education/Cour…

I'll release just a teaser under the form of a clinical case below. You might call on my partners in crime @Ph_Bertrand & @petranijst to do the same...

Have fun & see you live without #COVID next year!

How is diuretic efficiency changing with severity of #CKD? What is its prognostic relevance?
Read our new paper in CardioRenal Medicine!

@WilsonTangMD @BammensBert
Also thanks to Jeff Testani, Pieter Martens & Dirk Kuypers for their help with the paper... We used 3 metrics of diuretic efficiency, based on urine output, natriuresis & chloruresis.

Irrespectively of metric, loop diuretic efficiency decreased significantly from KDIGO class IV, while remaining relatively preserved in less advanced CKD.

Always nice to write an editorial together with partner-in-crime @kevin_damman! We dig into the question: "Is spironolactone a disease-modifying drug or diuretic in #HFpEF?" @ESC_Journals
onlinelibrary.wiley.com/doi/epdf/10.10…

Comment on:
onlinelibrary.wiley.com/doi/abs/10.100… Key points:
1. Spironolactone = most cost-effective drug in #HFrEF
2. Considering modest diuretic effects with 25-50mg, likely due to pleiotropic effects (Figure)
3. Natriuretic effects increase with dosing up to 600 mg (cirrhosis)
4. Average TOPCAT ~ RALES dose

Why #kidney function does not equal #GFR (and certainly not Cr), making it an elusive target in clinical practice & the latter a poor surrogate outcome, despite its robust correlation with prognosis. Caring for kidneys versus improving Cr/GFR. A thread below: The kidneys in essence have 3 functions:
1. Glomerular function = Clearance
2. Tubular function = Homeostasis
3. Neurohumoral function

GFR mainly reflects 1. So why do we take GFR (or its estimate Cr) as a surrogate for renal function?

Question to all #VExUS experts: "Do you ever diurese VExUS 0 ?" Thread below.
I admit not being a #VExUS user, but learned much from your tweets and have been practicing many #DiuresisJedi concepts.
@ArgaizR @msiuba @ThinkingCC @NephroP @load_dependent @khaycock2 @Thind888 Ever since I read this great paper, tend to consider volume status and cardiac filling pressures as 2 separate and equally important concepts that both deserve optimisation in #ICU and #HeartFailure.
Basically, V-p correlation is all over the place! (1/6)
journal.chestnet.org/article/S0012-…