Watanabe Yusuke, Nara Yugo, Hioki Hirofumi, Kawashima Hideyuki, Kataoka Akihisa, Nakashima Makoto, Nishihata Yosuke, Hayashida Kentaro, Yamamoto Masanori, Tanaka Jun, Mizutani Kazuki, Jujo Kentaro, Nakazawa Gaku, Izumo Masaki, Kozuma Ken
Teikyo University School of Medicine, Tokyo, Japan.
Teikyo University School of Medicine, Tokyo, Japan.
Int J Cardiol. 2020 Apr 15;305:82-86. doi: 10.1016/j.ijcard.2020.02.017. Epub 2020 Feb 7.
Tolvaptan exerts potent diuretic effects in heart failure patients without hemodynamic instability. Nonetheless, its clinical efficacy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) remains unclear. This study aimed to evaluate the short-term effects of tolvaptan in ADHF patients with severe AS.
The LOw-Dose Tolvaptan (7.5 mg) in Decompensated Heart Failure Patients with Severe Aortic Stenosis (LOHAS) registry is a multicenter (7 centers) prospective registry that assessed the short-term effects of tolvaptan in subjects hospitalized for ADHF with severe AS. A total of 59 subjects were enrolled between September 2014 and December 2017. The primary endpoints were changes in body weight and fluid balance measured daily from baseline up to 4 days.
The median [interquartile range] patient age and aortic valve area were 85.0 [81.0-89.0] years and 0.58 [0.42-0.74] cm, respectively. Body weight continuously decreased, and fluid balance was maintained from baseline to day 4 (p < 0.001, p = 0.194, respectively). Median serum B-type natriuretic peptide concentration significantly decreased from 910.5 to 740.0 pg/mL by day 4 (p = 0.002). However, systolic blood pressure and heart rate were non-significantly changed (p = 0.250, p = 0.656, respectively). Hypernatremia (>150 mEq/L) and worsening renal function occurred in 2 (3.4%) and 4 (6.8%) patients, respectively.
Short-term treatment with low-dose tolvaptan is safe and effective, providing stable hemodynamic parameters in patients with ADHF and severe AS.
托伐普坦对无血流动力学不稳定的心力衰竭患者具有显著的利尿作用。然而，其对严重主动脉瓣狭窄（AS）所致急性失代偿性心力衰竭（ADHF）的临床疗效仍不明确。本研究旨在评估托伐普坦对重度AS的ADHF患者的短期影响。
重度主动脉瓣狭窄失代偿性心力衰竭患者低剂量托伐普坦（7.5毫克）（LOHAS）登记研究是一项多中心（7个中心）前瞻性登记研究，评估托伐普坦对因重度AS住院的ADHF患者的短期影响。2014年9月至2017年12月期间共纳入59名受试者。主要终点是从基线到4天每天测量的体重和液体平衡变化。
患者年龄中位数[四分位间距]和主动脉瓣面积分别为85.0[81.0 - 89.0]岁和0.58[0.42 - 0.74]平方厘米。体重持续下降，从基线到第4天液体平衡得以维持（分别为p < 0.001，p = 0.194）。到第4天，血清B型利钠肽浓度中位数从910.5显著降至740.0 pg/mL（p = 0.002）。然而，收缩压和心率无显著变化（分别为p = 0.250，p = 0.656）。高钠血症（>150 mEq/L）和肾功能恶化分别发生在2例（3.4%）和4例（6.8%）患者中。
低剂量托伐普坦短期治疗安全有效，可为ADHF和重度AS患者提供稳定的血流动力学参数。
