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Publications

Journal Article Randomized Controlled Trial Multicenter Study Ppublish 2 citations

PubMed: 42523039 DOI: 10.1080/00015385.2026.2704235

Acetazolamide, residual congestion and clinical outcomes in acute heart failure - a prespecified analysis of the ADVOR trial.

Acta Cardiol 81(8):901-908

Authors: Evelyne M Meekers, Pieter Martens, Jeroen Dauw, Sebastiaan Dhont, Frederik H Verbrugge, Petra Nijst, Katrien Tartaglia, Fabien Chenot, Samer Moubayed, Riet Dierckx, Philippe Blouard, Pierre Troisfontaines, David Derthoo, Walter Smolders, Michaƫl Hulselmans, Stijn Lochy, Bavo Ector, David Raes, Hans Vandekerckhove, Emeline Van Craenenbroeck, Pieter-Jan Hofkens, Kathleen Goossens, Anne-Catherine Pouleur, Michel De Ceuninck, Philippe Timmermans, Laurence Gabriel, Walter Droogne, Edgard Prihadi, Frederik Van Durme, Michel De Pauw, Delphine Vervloet, Els Viaene, Jean-Luc Vachiery, Matthias Dupont, Wilfried Mullens

Affiliations

  • Department of Cardiology, Ziekenhuis Oost-Limburg A.V. Genk, Belgium.
  • Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek/Hasselt, Belgium.
  • Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Department of Cardiology, AZORG, Aalst, Belgium.
  • Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium.
  • Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium.
  • Department of Cardiology, Grand HĆ“pital de Charleroi, Charleroi, Belgium.
  • Department of Cardiology, CHU Charleroi, Charleroi, Belgium.
  • Department of Cardiology, Clinic Saint-Luc, Bouge, Belgium.
  • Department of Cardiology, CHR de la Citadelle, LiĆØge, Belgium.
  • Department of Cardiology, AZ Groeninge, Kortrijk, Belgium.
  • Department of Cardiology, AZ Klina, Brasschaat, Belgium.
  • Department of Cardiology, Ziekenhuis Maas & Kempen, Maaseik, Belgium.
  • Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium.
  • Department of Cardiology, ZAS Augustinus, Antwerp, Belgium.
  • Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium.
  • Department of Cardiology, University Hospital Antwerp, Edegem, Belgium.
  • Department of Cardiology, AZ Turnhout, Turnhout, Belgium.
  • Department of Cardiology, VITAZ, Sint-Niklaas, Belgium.
  • Department of Cardiology, University Hospital Saint-Luc, Sint-Lambrechts-Woluwe, Belgium.
  • Department of Cardiology, AZ Delta, Roeselare, Belgium.
  • Department of Cardiology, Hasselt, Belgium.
  • Department of Cardiology, CHU UCL Namur, Yvoir, Belgium.
  • Department of Cardiology, University Hospital Leuven, Leuven, Belgium.
  • Department of Cardiology, ZNA Middelheim, Antwerp, Belgium.
  • Department of Cardiology, AZ Glorieux, Ronse, Belgium.
  • Department of Cardiology, University Hospital Ghent, Ghent, Belgium.
  • Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
  • Department of Cardiology, Jan Yperman Ziekenhuis, Ieper, Belgium.
  • Department of Cardiology, Hospital Erasme, Bruxelles, Belgium.

Abstract

AIMS

Acetazolamide, an inhibitor of proximal tubular sodium reabsorption, improves decongestion in acute heart failure (AHF). The aim of the current subanalysis is to evaluate which factors influence decongestion success and the impact of acetazolamide on 3-month clinical outcomes.

METHODS

This analysis of the Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) trial, that randomised 519 patients with AHF to intravenous acetazolamide or matching placebo, assessed the relationship between acetazolamide treatment, residual congestion, and all-cause mortality and/or heart failure hospitalisation (HFH).

RESULTS

After 90Ā days, 148 patients (28.7%) experienced the combined endpoint of all-cause mortality and HFH. Predictors of the occurrence of this endpoint were higher baseline doses of loop diuretics (HR = 1.60; 95% CIĀ =Ā [1.26-2.03]; pĀ <Ā 0.001) and higher natriuretic peptide levels (HR = 1.34; 95% CIĀ =Ā [1.09-1.65]; pĀ =Ā 0.006). Acetazolamide lowered the risk of residual congestion (OR = 0.54, 95% CIĀ =Ā [0.36-0.82]), and residual congestion at day 4 (HR = 1.70, 95% CIĀ =Ā [1.18-2.43], pĀ =Ā 0.004) and at discharge (HR = 2.43, 95% CIĀ =Ā [1.76-3.36], pĀ <Ā 0.001) were associated with a worse clinical outcome. The presence of residual congestion despite use of acetazolamide was associated with the highest event rate for all-cause mortality or HFH (pĀ =Ā 0.019).

CONCLUSIONS

Residual congestion after decongestive treatment for AHF is associated with an increased risk of all-cause mortality and HFH. The upfront addition of acetazolamide reduced the incidence of residual congestion. However, patients with residual congestion despite acetazolamide use are at excessive risk for mortality and HFH, identifying a subset of patients requiring specialised heart failure care.

MeSH

Acetazolamide, Mortality, Heart Failure, Heart, Cardiology, Therapeutics, Prognosis