Seasonal Changes in Systemic Volume Overload Are to Be Considered

– Reply –

We thank Mizuno et al for their interest and important comments on our recent paper entitled “Clinical Scenario 1 is Associated with Winter Onset of Acute Heart Failure”,¹ published in the Circulation Journal. In that paper we concluded that a winter predominance of acute heart failure (AHF) was seen only in Clinical Scenario (CS) 1, and that lack of loop diuretic use was a risk factor for winter onset.

Firstly we would like to emphasize that the aim of our study was not to validate the usefulness of the CS classification. Although it is useful for physicians, particularly other than heart failure specialists, in deciding on the initial therapeutic strategy without time delay during the early in-hospital management of AHF,² we agree that this classification is not enough to understand the principal pathophysiology of AHF. As Mizuno et al pointed out, the degree of volume overload and/or shift is not taken into account by the CS. However, there is no established classification of AHF in the current era. Although there are several limitations, CS is referred to in the guideline of the Japanese Circulation Society and is currently utilized widely. Therefore, we divided the study subjects according to CS. The data from the West Tokyo Heart Failure Registry show that the frequency of CS1 was increased in winter in association with that of peripheral edema, and this may partly explain our conclusion. We agree that a new classification of AHF patients is required, and that further studies will be necessary to clarify how seasonal variation affects the onset of AHF and to determine the roles of each medication on the prevention of AHF.

Disclosures

None.

• Masayuki Hirai, MD
• Masahiko Kato, MD
• Kazuhiro Yamamoto, MD
• Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan

(Released online January 22, 2015)

References

• 1.    Hirai  M,  Kato  M,  Kinugasa  Y,  Sugihara  S,  Yanagihara  K,  Yamada  K, et al. Clinical scenario 1 is associated with winter onset of acute heart failure. Circ J 2015; 79: 129–135.
• 2.    Mebazaa  A,  Gheorghiade  M,  Piña  IL,  Harjola  VP,  Hollenberg  SM,  Follath  F, et al. Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 2008; 36(Suppl): S129–S139.