Vasodilator use and diuresis among patients admitted for an acute decompensation of heart failure. Preliminary results from the multicenters FOCUS-ADHF study
M Bertaina, A Galluzzo, G Pinto, E Rigamonti, D Stolfo, V Bovolo, G Del Monaco, S Contessi, F R Scopigni, S Calle, M Pagnesi, M Mapelli, M Gori, P Martens, W MullensAbstract
Background
Limited data is available on the role of vasodilators in promoting decongestion among selected patients hospitalized for acute decompensation of heart failure (ADHF) with severe left ventricular dysfunction, significant mitral regurgitation, and elevated filling and pulmonary artery pressures.
Purpose
To evaluate the association between early intravenous vasodilator therapy and diuresis in a selected ADHF population.
Methods
This is a preliminary analysis from the FOCUS-ADHF prospective multicenter observational study enrolling patients with ADHF, LVEF <40%, dilated LV and/or significant functional mitral regurgitation, increased filling and pulmonary artery pressures as estimated at index echocardiographic evaluation. Clinical, laboratory, echocardiographic,lung ultrasound,and treatment data were collected. The primary endpoint was first 48-hour diuresis expressed as mL/kg/hour.
Results
From May to December 2025, thirty-one patients were included (84% male; median age 70 years [IQR 63–80]). Included patients showed advanced cardiac dysfunction and congestion (median LVEF 27% [21–32], NT-proBNP 7191 pg/mL [4181–14546], E/e’ 20 [16–26], severe functional MR 39%). Median systolic blood pressure was 125 mmHg [110–140]. Sixteen patients (52%) received vasodilators (7 [44%] sodium nitroprusside and 9 [56%] nitroglycerin), with a median infusion duration of 48 hours [24–52]. Baseline clinical, laboratory and echocardiographic characteristics were comparable between those treated and not treated with vasodilators (Table 1). Vasodilator therapy was associated with a higher first 48-hour diuresis normalized for body weight (1.88 mL/kg/h [1.46–1.94] vs 1.37 [0.91–1.67]; p=0.02; Figure 1), despite similar loop diuretic doses within the first 48h (200 mg [160–320] vs 200 mg [120–300] furosemide equivalent; p=0.3).
Conclusion
In this preliminary FOCUS-ADHF analysis, early intravenous vasodilator use was associated with more effective short-term decongestion without baseline imbalances, supporting further evaluation of phenotype-guided vasodilator strategies in ADHF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.