The purpose of this study is to determine the safety and effectiveness of ultrahigh dose diuretics compared to standard dose diuretics over 24 hours in patients with decompensated heart failure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
20
Bumetanide will be administered via intravenous (IV) infusion at a dose of 12.5 mg two times a day (BID) for 2 doses total within 24 hours.
Furosemide will be administered via intravenous (IV) infusion at usual doses (twice the home dose of oral daily diuretic in furosemide equivalents) administered as 2 doses total within 24 hours. Furosemide equivalents will be considered as follows (40 mg of intravenous furosemide = 1 mg oral bumetanide or 40 mg of torsemide or 80 mg of oral furosemide consistent with prior literature). The lowest dose of furosemide administered during the study will be 40 mg IV two times a day (BID) and the maximum dose will be 100 mg IV BID.
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Urine Output
The total volume of urine produced in milliliters (mL) over 24 hours after initiation of intravenous diuretic.
Time frame: 24 hours
Change in Body Weight
Change in Body Weight (kg) from Baseline to 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in NT-proBNP
Change in NT-proBNP levels (pg/ml) from Baseline to 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Urine Sodium Excretion
Change in amount of sodium (mmol) excreted in the urine from Baseline to 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Apnea-hypopnea Index
The apnea-hypopnea index (AHI) is the number of apneas and hypopneas per hour of sleep which is an indicator of severity of sleep apnea AHI will be measured using a Watch Pat or Nox device at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Iohexol Glomerular Filtration Rate (GFR)
Renal or kidney function was measured by GFR determined by Iohexol clearance. Iohexol GFR will be measured at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Peripheral Vein Pressure
Peripheral vein pressure (mm Hg) will be recorded from existing IV lines through pressure transducer monitoring at Baseline and 24 hours after initiation of intravenous diuretic.
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Time frame: Baseline, 24 hours
Change in Cardiac Output
Cardiac output (L/min) is the total volume of blood moved by the heart per minute and will be measured by echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Estimated Right Ventricular (RV) Systolic Pressure
Estimated RV systolic pressure (mm Hg) will be measured by echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Right Atrial (RA) Pressure
RA pressure (mm Hg) will be measured by echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Left Atrial (LA) Strain
LA strain will be assessed by echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Left Ventricular (LV) Global Longitudinal Strain
LV global longitudinal strain will be assessed by echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in Right Ventricular (RV) Global Longitudinal Strain
RV global longitudinal strain will be assessed by echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic.
Time frame: Baseline, 24 hours
Change in E/e'
E/e' will be assessed using echocardiography conducted at Baseline and 24 hours after initiation of intravenous diuretic. It is defined as the ratio of peak early diastolic mitral inflow velocity (E) and peak early diastolic mitral annular velocity (e').
Time frame: Baseline, 24 hours