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Escobar Cervantes, L. Manzano" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Escobar Cervantes" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Manzano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425651930027X" "doi" => "10.1016/j.rce.2019.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651930027X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488741930027X?idApp=WRCEE" "url" => "/22548874/0000021900000002/v1_201902270625/S225488741930027X/v1_201902270625/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Hemoconcentration and acute heart failure, an emerging predictive factor or already established?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "32" "paginaFinal" => "33" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "C. Escobar Cervantes" "autores" => array:1 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Escobar Cervantes" "email" => array:1 [ 0 => "escobar_cervantes_carlos@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cardiología, Hospital U. la Paz, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemoconcentración e insuficiencia cardiaca aguda, ¿un factor predictor emergente o ya consolidado?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute heart failure (HF) is one of the main reasons for hospitalization for patients older than 65 years and has a direct effect on patient mortality and quality of life, as well as on healthcare costs.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Reports have also indicated that 1 of every 4 patients hospitalized for HF are readmitted in the first month after the hospital discharge, which could be partly related to insufficient decongestion during the hospitalization and to early discharge.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> In fact, most patients with decompensated HF still have residual congestion 7 days after the hospitalization, a fact that is associated with higher rehospitalization and mortality rates.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Reducing congestive symptoms in patients with HF through appropriate diuretic therapy is therefore essential.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> In daily clinical practice, however, questions frequently arise as to the appropriate intensity of the diuretic therapy in particular patients, especially since intensive diuretic therapy is sometimes associated with certain renal function impairment, which can motivate physicians to decrease the therapy's intensity. Accordingly, we need to find surrogate parameters that indicate whether the decongestive therapy is truly effective in patients with acute HF.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> One of the proposed markers is the degree of hemoconcentration as the result of intensive diuretic therapy, which decreases the electrolyte content of the intravascular space, to a greater degree than the displacement of interstitial fluid to this space.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Hemoconcentration is therefore an indirect sign of intensive diuretic therapy. Several studies have shown that patients hospitalized for acute HF who have a higher hemoconcentration are administered a higher dosage of diuretics and have greater weight loss during the hospitalization.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Although studies have observed that patients with acute HF and a higher hemoconcentration associated with intensive diuretic therapy can present renal function impairment,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6–9</span></a> the impairment is not associated with a greater risk of cardiovascular complications. A number of authors therefore talk of “pseudo-worsening” renal function, rather than actual worsening with prognostic consequences.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> In fact, most studies have shown that the hemoconcentration associated with intensive diuretic therapy, during the hospitalization of patients with acute HF, is associated with lower mortality and risk of readmissions for HF.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6–10</span></a> However, we need to establish criteria that define hemoconcentration and its prognostic utility, according to certain variables, such as the patient's clinical profile, status at admission and other parameters with prognostic implications such as hyponatremia.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6–11</span></a> In any case, the lack of this hemoconcentration during hospitalization signals inadequate diuretic therapy,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> necessitating the search for alternatives to optimize the diuretic therapy.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The study by Grau Amorós et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> sought to increase our understanding of hemoconcentration as a predictor for patients with acute HF, analyzing the prognostic value, degree of hemoconcentration at 3 months of discharge for acute HF both in terms of mortality and readmissions for HF during 1 year of follow-up after the discharge. To this end, the authors analyzed a wide sample of patients hospitalized for acute HF in hospitals throughout Spain. Although this study had a tendency towards lower mortality and fewer readmissions for HF in the patients with increased hemoconcentration, the trend was not statistically significant.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly, it is apparent that greater decongestion during hospitalization, manifested by hemoconcentration, is associated with a better prognosis. However, as the decongestion decreases, the predictive capacity of hemoconcentration decreases. Moreover, certain renal function impairment during hospitalization should not limit the intensive diuretic therapy if the patient requires the therapy. Although hemoconcentration is an easy parameter to measure, there are still several issues that need more research, such as the definition of hemoconcentration itself, at what point during the admission/early discharge should it be measured, should it be considered differently depending on the type of HF (reduced vs. preserved ejection fraction), and how should patient follow-up be conducted after discharge (frequency of visits and intensification of diuretic therapy), according to the level of hemoconcentration achieved during the hospitalization.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In short and despite the fact that future studies should clarify these issues, it seems at this time that hemoconcentration during hospitalization and during the first days after the discharge is a simple parameter to measure, and all clinicians should consider hemoconcentration when managing patients with HF. The study by Grau et al. suggested that measuring the hemoconcentration during follow-up after hospitalization for HF could have certain usefulness.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escobar Cervantes C. Hemoconcentración e insuficiencia cardiaca aguda, ¿un factor predictor emergente o ya consolidado? Rev Clin Esp. 2019;219:32–33.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ESC Scientific Document Group" "etal" => true "autores" => array:6 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" 3 => "H. Bueno" 4 => "J.G.F. Cleland" 5 => "A.J.S. 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