Abstract：
Acute heart failure (AHF) is characterized by the emergence or intensification of symptoms and signs indicative of congestion or systemic hypoperfusion, stemming from an underlying structural or functional cardiac disorder. Intravenous loop diuretics play a pivotal role in achieving effective decongestion and ensuring clinical stability; the efficacy of these medications is crucial for determining the patient\'s hospital course and early outpatient progression. Individuals who exhibit a suboptimal response to diuretics or develop diuretic resistance (DR) are at an elevated risk for cardiovascular mortality and readmission due to AHF. However, there is a lack of standardized definition and diagnostic criteria for DR. Early identification of patients with DR is critical, as they may benefit from more aggressive decongestion strategies to mitigate this resistance. Natriuresis, the excretion of sodium in urine, serves as a direct measure of a diuretic\'s effectiveness. Low levels of natriuresis have been linked to poorer outcomes. Several studies have underscored the prognostic significance of natriuresis across various heart failure scenarios. However, the relationship between natriuresis and in-hospital DR has not been extensively studied. Observational research has indicated that inadequate natriuresis following the administration of loop diuretics correlates with a diminished diuretic response and an increased likelihood of mortality and heart failure rehospitalization. Further investigation is warranted to assess the predictive value of basal natriuresis concerning DR, in-hospital outcomes, and early outpatient cardiovascular events. This would help in identifying patients who are likely to respond poorly to diuretic therapy and may require alternative or more intensive treatment approaches.
摘要：
急性心力衰竭（AHF）的特征是出现或加剧的症状和体征表明充血或全身灌注不足，源于潜在的结构性或功能性心脏病。静脉环路利尿剂在实现有效的充血和确保临床稳定性方面起着关键作用；这些药物的疗效对于确定患者的住院过程和早期门诊进展至关重要。对利尿剂表现出次优反应或发展为利尿剂抵抗(DR)的个体由于AHF而处于心血管死亡和再入院的升高风险。然而,DR缺乏标准化的定义和诊断标准。早期识别DR患者至关重要，因为他们可能会从更积极的缓解充血策略中受益，以减轻这种抵抗力。利尿,尿液中钠的排泄，作为利尿剂有效性的直接衡量标准。低钠尿症与较差的结果有关。几项研究强调了利钠在各种心力衰竭情况下的预后意义。然而,钠尿和院内DR之间的关系尚未得到广泛研究.观察性研究表明，使用loop利尿剂后利尿不足与利尿剂反应减弱以及死亡率和心力衰竭再住院的可能性增加相关。有必要进一步调查以评估与DR有关的基底尿钠的预测价值，住院结果，和早期门诊心血管事件。这将有助于识别可能对利尿剂治疗反应不佳的患者，并且可能需要替代或更强化的治疗方法。
