{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T23:48:05Z","timestamp":1776383285326,"version":"3.51.2"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long\u2010term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Consecutive patients with severe AS with [\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009157; median (interquartile range) daily torasemide dose: 10 (5\u201315)\u2009mg] or without (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009346) LDT undergoing a detailed assessment of congestion (B\u2010type natriuretic peptide, liver enzymes, systematic chest X\u2010ray analysis) and cardiac catheterization before AVR with a post\u2010AVR follow\u2010up of several years were studied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Despite similar AS severity (indexed aortic valve area 0.41\u2009\u00b1\u20090.12 vs. 0.43\u2009\u00b1\u20090.12\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      ) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B\u2010type natriuretic peptide [446 (245\u2013991) vs. 150 (62\u2013317)\u2009ng\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001], higher liver enzymes, higher chest x\u2010ray congestion score [2 (1\u20134.5) vs. 1 (0\u20132) score points;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001], and higher mean right atrial pressure (8\u2009\u00b1\u20094 vs\n                      <jats:italic>.<\/jats:italic>\n                      6\u2009\u00b1\u20093\u2009mmHg) and mean pulmonary artery wedge pressure (21\u2009\u00b1\u20098 vs. 14\u2009\u00b1\u20096\u2009mmHg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for both) than those without. After a median post\u2010AVR follow\u2010up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37\u2009\u00b1\u200911 vs\n                      <jats:italic>.<\/jats:italic>\n                      32\u2009\u00b1\u20098\u2009mmHg;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and after a median follow\u2010up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17\u20133.77);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01] in LDT compared to non\u2010LDT patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post\u2010AVR status, and increased post\u2010AVR long\u2010term mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70225","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T11:59:08Z","timestamp":1764417548000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Loop Diuretic Therapy in Severe Aortic Stenosis: Marker of Organ Congestion, Unfavorable Hemodynamics, and Increased Post\u2010Valve Replacement Mortality"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7036-5791","authenticated-orcid":false,"given":"Micha T.","family":"Maeder","sequence":"first","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"},{"name":"University of Basel Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Breuss","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"},{"name":"Clinic of Intensive Care University Hospital Z\u00fcrich Z\u00fcrich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Appert","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Wildermuth","sequence":"additional","affiliation":[{"name":"Department of Radiology Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp K.","family":"Haager","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Rigger","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joannis","family":"Chronis","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin O.","family":"Schmiady","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac Surgery University Hospital Z\u00fcrich  Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Rickli","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Cardiology HOCH Health Ostschweiz, Kantonsspital St. Gallen St. Gallen Switzerland"},{"name":"Departmentof Cardiology and Cardio\u2010Vascular Surgery H\u00f4spital Cardiologique de Haut\u2010L\u00e9v\u00eaque, Bordeaux University Hospital  France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae483"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_11_4_1","first-page":"876","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich P. 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