Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland.
Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruna, CIBERCV, La Coruna, Spain.
Cardiovasc Drugs Ther. 2019 Feb;33(1):77-86. doi: 10.1007/s10557-018-6843-5.
Current clinical recommendations do not emphasise superiority of any of diuretics, but available reports are very encouraging and suggest beneficial effects of torasemide. This study aimed to compare the effect of torasemide and furosemide on long-term outcomes and New York Heart Association (NYHA) class change in patients with chronic heart failure (HF).
Of 2019 patients enrolled in Polish parts of the heart failure registries of the European Society of Cardiology (Pilot and Long-Term), 1440 patients treated with a loop diuretic were included in the analysis. The main analysis was performed on matched cohorts of HF patients treated with furosemide and torasemide using propensity score matching.
Torasemide was associated with a similar primary endpoint (all-cause death; 9.8% vs. 14.1%; p = 0.13) occurrence and 23.8% risk reduction of the secondary endpoint (a composite of all-cause death or hospitalisation for worsening HF; 26.4% vs. 34.7%; p = 0.04). Treatment with both torasemide and furosemide was associated with the significantly most frequent occurrence of the primary (23.8%) and secondary (59.2%) endpoints. In the matched cohort after 12 months, NYHA class was higher in the furosemide group (p = 0.04), while furosemide use was associated with a higher risk (20.0% vs. 12.9%; p = 0.03) of worsening ≥ 1 NYHA class. Torasemide use impacted positively upon the primary endpoint occurrence, especially in younger patients (aged < 65 years) and with dilated cardiomyopathy.
Our findings contribute to the body of research on the optimal diuretic choice. Torasemide may have advantageous influence on NYHA class and long-term outcomes of HF patients, especially younger patients or those with dilated cardiomyopathy, but it needs further investigations in prospective randomised trials.
目前的临床建议并未强调任何一种利尿剂的优越性，但现有报告非常令人鼓舞，并表明托拉塞米具有有益的效果。本研究旨在比较托拉塞米和呋塞米对慢性心力衰竭（HF）患者长期结局和纽约心脏协会（NYHA）心功能分级变化的影响。
在欧洲心脏病学会（ESC）心力衰竭注册研究的波兰部分纳入的 2019 例患者中，纳入了 1440 例接受袢利尿剂治疗的患者进行分析。主要分析是在接受呋塞米和托拉塞米治疗的 HF 患者匹配队列中进行的，采用倾向评分匹配法。
托拉塞米与相似的主要终点（全因死亡；9.8% vs. 14.1%；p=0.13）发生率和 23.8%的次要终点（全因死亡或因 HF 恶化住院的复合终点；26.4% vs. 34.7%；p=0.04）风险降低相关。托拉塞米和呋塞米的治疗均与主要终点（23.8%）和次要终点（59.2%）的发生率最高显著相关。在 12 个月后的匹配队列中，呋塞米组 NYHA 心功能分级更高（p=0.04），而呋塞米的使用与更高的风险（20.0% vs. 12.9%；p=0.03）相关，NYHA 心功能分级恶化≥1 级。托拉塞米的使用对主要终点的发生有积极影响，特别是在年轻患者（年龄<65 岁）和扩张型心肌病患者中。
我们的研究结果为最佳利尿剂选择的研究提供了依据。托拉塞米可能对 HF 患者的 NYHA 心功能分级和长期结局有有利影响，特别是年轻患者或扩张型心肌病患者，但需要进一步的前瞻性随机试验研究。
