Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine.
Kurume Med J. 2022 Mar 11;67(1):11-16. doi: 10.2739/kurumemedj.MS671001. Epub 2021 Nov 26.
Heart failure in severe aortic stenosis (AS) before aortic valve has a poor prognosis with high risk. Although the overuse of loop diuretics may induce hypovolemia, cardiac output reduction, and critical hypotension in severe AS, tolvaptan is characterized by its ability to help maintain hemodynamics and seems to be appropriate for use in heart failure caused by AS. Therefore, we retrospectively examined the effects and safety of tolvaptan use in patients with heart failure caused by severe AS.
Ten patients with heart failure caused by severe AS were enrolled. Tolvaptan administration did not cause blood pressure decrease significantly, whereas urine volume increased significantly from 896±318 to 1322±502 mL/day (P<0.05). Although there was no statistical significance, functional classes tended to be improved. Blood tests indicated no worsening of kidney function and N-terminal pro-brain natriuretic peptide levels after the use of tolvaptan. Echocardiography also showed no hypovolemia and no worsening of aortic valve flow (18.3±3.8 to 15.5±5.5 cm/s, n.s).
Tolvaptan use in AS patients with heart failure is effective and safe before aortic valve intervention.
严重主动脉瓣狭窄（AS）患者在主动脉瓣置换之前出现心力衰竭预后较差，风险较高。尽管在严重 AS 中过度使用袢利尿剂可能会导致血容量不足、心输出量减少和严重低血压，但托伐普坦的特点是能够帮助维持血流动力学，似乎适用于 AS 引起的心力衰竭。因此，我们回顾性地检查了托伐普坦在严重 AS 引起的心力衰竭患者中的疗效和安全性。
共纳入 10 例严重 AS 合并心力衰竭患者。托伐普坦的使用并未导致血压明显下降，而尿量从 896±318 增加至 1322±502 mL/天（P<0.05）。尽管无统计学意义，但心功能分级趋于改善。血液检查显示托伐普坦使用后肾功能和 N 末端脑利钠肽前体水平无恶化。超声心动图也显示无血容量不足和主动脉瓣血流恶化（18.3±3.8 至 15.5±5.5 cm/s，无统计学意义）。
在主动脉瓣介入治疗之前，托伐普坦在 AS 合并心力衰竭患者中的使用是有效和安全的。
