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  • At least 1 sign of volume overload (oedema, ascitis, pleural effusion)

  • ≥  1 month maintenance dose of loop diuretics (≥  1 mg  bumetanide, ≥ 40 mg  furosemide, ≥  20 mg torsemide)

  • BNP > 250 pg/ml or NT-proBNP > 1000 pg/ml

  • Assessed LVEF by any imaging techniques within 12 months of inclusion


  • At admission / screening
    – Treatment with acetazolamide and/or IV loop diuretics > 2 mg prior to randomization
    – Estimated glomerular filtration rate <20 mL/min/1.73m²
    – Systolic blood pressure <90mm Hg or MAP <65mm Hg
    – Pregnant/breastfeeding subjects
    – Diagnosis of acute coronary syndrome
    – Current or expected use of “forbidden” agents (e.g. SGLT-2 inhibitors, IV inotropes, vasopressors or

  • At any time before study inclusion
    – History of congenital heart disease or cardiac transplantation and/or ventricular assist device
    – Use of renal replacement therapy or ultrafiltration

  • Use of any non-protocol defined diuretic agent should be stopped upon study inclusion

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