Acute Effects of Furosemide on Hemodynamics and Pulmonary Congestion in Acute Decompensated Heart Failure.

Summary

Intravenous (IV) loop diuretics have been a key component in treating pulmonary edema since the 1960s and has a Class 1 recommendation in the 2021 guidelines for acute heart failure. However, no randomized clinical trials have investigated loop diuretics versus other interventions for acute heart failure, and clinical knowledge of the hemodynamic effects of furosemide is based in studies from the 1970s. In this study, we aim to assess the acute effect of furosemide on cardiac filling pressures and pulmonary congestion. Hypothesis: Administration of furosemide induces a hyperacute (within 30 minutes) lowering of cardiac filling pressures and pulmonary congestion before significant diuresis occurs. Design: A prospective, interventional study including 20 patients admitted due to a clinical diagnosis of acute heart failure with pulmonary congestion. Intervention: 80 mg of furosemide is administered IV. Measurements include blood pressure, peripheral oxygen saturation, pulmonary fluid content by ReDS\*, ultrasound examination of heart and lungs, and assessment of cardiac filling pressures with doppler and strain analysis. Measurements are repeated at several time points until 6 hours have passed.

Timeline

Start

2023-09-01

Primary completion

2024-02-09

Completion

2024-02-09

Outcome

Missed primary endpoint

paper No significant reduction in ReDS was observed at any time point; a non-significant decrease of 1.7% was observed at 20 minutes (p = 0.32). PMID 41773006 ↗

Publications

• El Caidi NO, Lukoschewitz JD, Taraldsen IA, Hove J, Seven E, Dixen U, Grund F, Petersen M, Foss NB, Grand J. Acute haemodynamic and diuretic effects of intravenous furosemide in acute heart failure. Dan Med J. 2026 Feb 19;73(3):A07250556. doi: 10.61409/A07250556.
• El Caidi NO, Lukoschewitz JD, Nielsen OW, Hove J, Seven E, Dixen U, Grund F, Petersen M, Foss NB, Grand J. The acute effects of furosemide in acute heart failure assessed by remote dielectric sensing. A protocol. Dan Med J. 2024 Jun 12;71(7):A11230697. doi: 10.61409/A11230697.

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