Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University.
Int Heart J. 2022 Mar 30;63(2):247-254. doi: 10.1536/ihj.21-558. Epub 2022 Mar 18.
The recommended starting dose of Tolvaptan for heart failure (HF) is 7.5 mg/day in Japan; the recommended dose is 3.75 mg/day for older patients to avoid excessive diuresis and hypernatremia. However, low-dose Tolvaptan may delay the release of congestion in some patients. We aimed to develop a score to predict treatment responders to 3.75 mg tolvaptan.We retrospectively analyzed 106 patients with HF who initially received 3.75 mg/day of Tolvaptan in the derivation cohort (April 2013-December 2017) and 63 patients receiving 3.75 mg/day of Tolvaptan in the validation cohort (January 2018-April 2021). Treatment responders to 3.75 mg tolvaptan did not require dose escalation of Tolvaptan for congestion relief. In multivariate analysis, blood urea nitrogen (BUN) < 39 mg/dL and hematocrit > 35% were selected as variables to predict treatment responders. These were assigned 1 point each, and patients were stratified into groups with 2 points (n = 32), 1 point (n = 39), and 0 points (n = 35). The frequency of treatment responders was 82.9% in the 2-point group, 61.5% in the 1-point group, and 34.4% in the 0-point group (P < 0.05). The predictive ability of the score was acceptable with an area under the receiving operator characteristic curve (AUC) 0.726 (P < 0.05); its performance was maintained in the validation cohort (AUC 0.733, P < 0.05).A simple score using BUN and hematocrit could identify treatment responders to 3.75 mg tolvaptan, which may help determine the appropriate starting dose of Tolvaptan, balancing efficiency with safety for older patients with HF.
托伐普坦治疗心力衰竭（HF）的推荐起始剂量为 7.5mg/天；对于老年患者，推荐剂量为 3.75mg/天，以避免过度利尿和高钠血症。然而，低剂量托伐普坦可能会延迟某些患者充血的缓解。我们旨在开发一种评分来预测对 3.75mg 托伐普坦治疗有反应的患者。我们回顾性分析了在推导队列（2013 年 4 月至 2017 年 12 月）中最初接受 3.75mg/天托伐普坦治疗的 106 例 HF 患者和在验证队列（2018 年 1 月至 2021 年 4 月）中接受 3.75mg/天托伐普坦治疗的 63 例患者。对 3.75mg 托伐普坦治疗有反应的患者不需要为缓解充血而增加托伐普坦的剂量。多变量分析中，选择血尿素氮（BUN）<39mg/dL 和红细胞压积>35%作为预测治疗有反应者的变量。每个变量各分配 1 分，将患者分为 2 分（n=32）、1 分（n=39）和 0 分（n=35）组。2 分组的治疗反应者频率为 82.9%，1 分组为 61.5%，0 分组为 34.4%（P<0.05）。该评分的预测能力可接受，接受者操作特征曲线（AUC）下面积为 0.726（P<0.05）；在验证队列中也保持了良好的性能（AUC 0.733，P<0.05）。使用 BUN 和红细胞压积的简单评分可以识别对 3.75mg 托伐普坦治疗有反应的患者，这可能有助于为老年 HF 患者确定适当的托伐普坦起始剂量，在效率和安全性之间取得平衡。
