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  1. Article ; Online: The salt paradox in heart failure.

    Cox, Zachary L / Testani, Jeffrey M

    European journal of heart failure

    2024  

    Language English
    Publishing date 2024-03-11
    Publishing country England
    Document type Editorial
    ZDB-ID 1483672-5
    ISSN 1879-0844 ; 1388-9842
    ISSN (online) 1879-0844
    ISSN 1388-9842
    DOI 10.1002/ejhf.3194
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    Zs.A 5299: Show issues Location:
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  2. Article ; Online: "Pouring Salt in the Wound": Sodium Restriction in Acute Heart Failure.

    Cox, Zachary L / Testani, Jeffrey M

    Journal of cardiac failure

    2023  Volume 29, Issue 7, Page(s) 997–999

    MeSH term(s) Humans ; Heart Failure ; Sodium ; Sodium Chloride, Dietary ; Diet, Sodium-Restricted ; Sodium, Dietary
    Chemical Substances Sodium (9NEZ333N27) ; Sodium Chloride, Dietary ; Sodium, Dietary
    Language English
    Publishing date 2023-05-24
    Publishing country United States
    Document type Editorial
    ZDB-ID 1281194-4
    ISSN 1532-8414 ; 1071-9164
    ISSN (online) 1532-8414
    ISSN 1071-9164
    DOI 10.1016/j.cardfail.2023.05.007
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  3. Article ; Online: SGLT2 inhibitors and diuretics in heart failure: clicking reset on the renal volume setpoint?

    Borlaug, Barry A / Testani, Jeffrey M

    European heart journal

    2023  Volume 44, Issue 31, Page(s) 2944–2946

    MeSH term(s) Humans ; Diuretics/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/pharmacology ; Heart Failure/drug therapy ; Benzhydryl Compounds
    Chemical Substances Diuretics ; Sodium-Glucose Transporter 2 Inhibitors ; dapagliflozin (1ULL0QJ8UC) ; Benzhydryl Compounds
    Language English
    Publishing date 2023-07-10
    Publishing country England
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Comment
    ZDB-ID 603098-1
    ISSN 1522-9645 ; 0195-668X
    ISSN (online) 1522-9645
    ISSN 0195-668X
    DOI 10.1093/eurheartj/ehad345
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    Zs.MO 640: Show issues

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  4. Article ; Online: Congestion and Decongestion Assessment in Heart Failure: Pressure, Volume, or Both?

    Biegus, Jan / Borlaug, Barry A / Testani, Jeffrey M

    JACC. Heart failure

    2023  Volume 11, Issue 8 Pt 2, Page(s) 1152–1156

    MeSH term(s) Humans ; Heart Failure/complications ; Heart Failure/diagnosis
    Language English
    Publishing date 2023-08-21
    Publishing country United States
    Document type Editorial ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 2705621-1
    ISSN 2213-1787 ; 2213-1779
    ISSN (online) 2213-1787
    ISSN 2213-1779
    DOI 10.1016/j.jchf.2023.05.034
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  5. Article ; Online: Updates in Cardiorenal Syndrome.

    McCallum, Wendy / Testani, Jeffrey M

    The Medical clinics of North America

    2023  Volume 107, Issue 4, Page(s) 763–780

    Abstract: Cardiorenal syndrome is a term that refers to a collection of disorders involving both the heart and kidneys, encompassing multi-directional pathways between the 2 organs mediated through low arterial perfusion, venous congestion, and neurohormonal ... ...

    Abstract Cardiorenal syndrome is a term that refers to a collection of disorders involving both the heart and kidneys, encompassing multi-directional pathways between the 2 organs mediated through low arterial perfusion, venous congestion, and neurohormonal activation. The pathophysiology is complex and includes hemodynamic and neurohormonal changes, but inconsistent findings from recent studies suggest this is very heterogenous disorder. Management for ADHF remains focused on decongestion and neurohormonal blockade to overcome the intense sodium and fluid avidity of the CRS.
    MeSH term(s) Humans ; Cardio-Renal Syndrome/diagnosis ; Cardio-Renal Syndrome/drug therapy ; Heart Failure
    Language English
    Publishing date 2023-04-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 215710-x
    ISSN 1557-9859 ; 0025-7125
    ISSN (online) 1557-9859
    ISSN 0025-7125
    DOI 10.1016/j.mcna.2023.03.011
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  6. Article ; Online: Improved Decongestion With Devices in Decompensated Heart Failure: Does the End Justify the Means?

    Testani, Jeffrey M / Butler, Javed / Packer, Milton

    JACC. Heart failure

    2023  Volume 11, Issue 11, Page(s) 1576–1578

    MeSH term(s) Humans ; Heart Failure/therapy ; Diuretics ; Acute Disease
    Chemical Substances Diuretics
    Language English
    Publishing date 2023-11-07
    Publishing country United States
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 2705621-1
    ISSN 2213-1787 ; 2213-1779
    ISSN (online) 2213-1787
    ISSN 2213-1779
    DOI 10.1016/j.jchf.2023.07.006
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  7. Article ; Online: Critical Analysis of the Effects of SGLT2 Inhibitors on Renal Tubular Sodium, Water and Chloride Homeostasis and Their Role in Influencing Heart Failure Outcomes.

    Packer, Milton / Wilcox, Christopher S / Testani, Jeffrey M

    Circulation

    2023  Volume 148, Issue 4, Page(s) 354–372

    Abstract: SGLT2 (sodium-glucose cotransporter 2) inhibitors interfere with the reabsorption of glucose and sodium in the early proximal renal tubule, but the magnitude and duration of any ensuing natriuretic or diuretic effect are the result of an interplay ... ...

    Abstract SGLT2 (sodium-glucose cotransporter 2) inhibitors interfere with the reabsorption of glucose and sodium in the early proximal renal tubule, but the magnitude and duration of any ensuing natriuretic or diuretic effect are the result of an interplay between the degree of upregulation of SGLT2 and sodium-hydrogen exchanger 3, the extent to which downstream compensatory tubular mechanisms are activated, and (potentially) the volume set point in individual patients. A comprehensive review and synthesis of available studies reveals several renal response patterns with substantial variation across studies and clinical settings. However, the common observation is an absence of a large acute or chronic diuresis or natriuresis with these agents, either when given alone or combined with other diuretics. This limited response results from the fact that renal compensation to these drugs is rapid and nearly complete within a few days or weeks, preventing progressive volume losses. Nevertheless, the finding that fractional excretion of glucose and lithium (the latter being a marker of proximal sodium reabsorption) persists during long-term treatment with SGLT2 inhibitors indicates that pharmacological tolerance to the effects of these drugs at the level of the proximal tubule does not meaningfully occur. This persistent proximal tubular effect of SGLT2 inhibitors can be hypothesized to produce a durable improvement in the internal set point for volume homeostasis, which may become clinically important during times of fluid expansion. However, it is difficult to know whether a treatment-related change in the volume set point actually occurs or contributes to the effect of these drugs to reduce the risk of major heart failure events. SGLT2 inhibitors exert cardioprotective effects by a direct effect on cardiomyocytes that is independent of the presence of or binding to SGLT2 or the actions of these drugs on the proximal renal tubule. Nevertheless, changes in the volume set point mediated by SGLT2 inhibitors might potentially act cooperatively with the direct favorable molecular and cellular effects of these drugs on cardiomyocytes to mediate their benefits on the development and clinical course of heart failure.
    MeSH term(s) Humans ; Sodium-Glucose Transporter 2 Inhibitors ; Chlorides ; Sodium-Glucose Transporter 2 ; Sodium ; Water ; Homeostasis ; Diuretics ; Heart Failure ; Glucose
    Chemical Substances Sodium-Glucose Transporter 2 Inhibitors ; Chlorides ; Sodium-Glucose Transporter 2 ; Sodium (9NEZ333N27) ; Water (059QF0KO0R) ; Diuretics ; Glucose (IY9XDZ35W2)
    Language English
    Publishing date 2023-07-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80099-5
    ISSN 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
    ISSN (online) 1524-4539
    ISSN 0009-7322 ; 0069-4193 ; 0065-8499
    DOI 10.1161/CIRCULATIONAHA.123.064346
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    Ui IV Zs.60: Show issues Location:
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  8. Article ; Online: Classic and Novel Mechanisms of Diuretic Resistance in Cardiorenal Syndrome.

    Cox, Zachary L / Rao, Veena S / Testani, Jeffrey M

    Kidney360

    2022  Volume 3, Issue 5, Page(s) 954–967

    Abstract: Despite the incompletely understood multiple etiologies and underlying mechanisms, cardiorenal syndrome is characterized by decreased glomerular filtration and sodium avidity. The underlying level of renal sodium avidity is of primary importance in ... ...

    Abstract Despite the incompletely understood multiple etiologies and underlying mechanisms, cardiorenal syndrome is characterized by decreased glomerular filtration and sodium avidity. The underlying level of renal sodium avidity is of primary importance in driving a congested heart failure phenotype and ultimately determining the response to diuretic therapy. Historically, mechanisms of kidney sodium avidity and resultant diuretic resistance were primarily extrapolated to cardiorenal syndrome from non-heart failure populations. Yet, the mechanisms appear to differ between these populations. Recent literature in acute decompensated heart failure has refuted several classically accepted diuretic resistance mechanisms and reshaped how we conceptualize diuretic resistance mechanisms in cardiorenal syndrome. Herein, we propose an anatomically based categorization of diuretic resistance mechanisms to establish the relative importance of specific transporters and translate findings toward therapeutic strategies. Within this categorical structure, we discuss classic and novel mechanisms of diuretic resistance.
    MeSH term(s) Cardio-Renal Syndrome/drug therapy ; Diuretics/pharmacology ; Heart Failure/drug therapy ; Humans ; Sodium/therapeutic use ; Sodium Potassium Chloride Symporter Inhibitors/therapeutic use
    Chemical Substances Diuretics ; Sodium Potassium Chloride Symporter Inhibitors ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2022-03-01
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0006372021
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  9. Article ; Online: "Dip" in eGFR: Stay the Course With SGLT-2 Inhibition.

    Umanath, Kausik / Testani, Jeffrey M / Lewis, Julia B

    Circulation

    2022  Volume 146, Issue 6, Page(s) 463–465

    MeSH term(s) Diabetes Mellitus, Type 2/drug therapy ; Humans ; Hypoglycemic Agents/pharmacology ; Hypoglycemic Agents/therapeutic use
    Chemical Substances Hypoglycemic Agents
    Language English
    Publishing date 2022-08-08
    Publishing country United States
    Document type Editorial
    ZDB-ID 80099-5
    ISSN 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
    ISSN (online) 1524-4539
    ISSN 0009-7322 ; 0069-4193 ; 0065-8499
    DOI 10.1161/CIRCULATIONAHA.122.060823
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  10. Article ; Online: The Reply.

    McCallum, Wendy / Testani, Jeffrey M / Sarnak, Mark J

    The American journal of medicine

    2022  Volume 135, Issue 10, Page(s) e400

    Language English
    Publishing date 2022-10-05
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2022.06.012
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