Małek-Elikowska Małgorzata, Szyszka Andrzej, Fedorowicz Julita, Dankowski Rafał, Szymańska Cyntia, Baszko Artur
2nd Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
Front Pharmacol. 2025 Jul 31;16:1643077. doi: 10.3389/fphar.2025.1643077. eCollection 2025.
Intravenous (IV) furosemide and torsemide represent a cornerstone of guideline-directed medical therapy for acute heart failure (AHF). However, the evidence regarding the superiority of each agent remains controversial.
The prospective, open-label, comparative study included 51 adult patients hospitalized due to AHF. Torsemide was administered to 25 patients (49%), and furosemide to 26 patients (51%). The primary endpoint was the change in urinary spot sodium level at 24 h, used to assess diuretic efficacy. Secondary outcomes included lung ultrasound (LUS) B-lines, clinical status evaluation based on the Borg scale, Killip-Kimball classification, and daily urine output.
After 24 h of treatment, urinary sodium levels increased by an estimated marginal mean (EMM) of 21.84 mmol/L in the furosemide group and 0.97 mmol/L in the torsemide group (p = 0.173). The number of B-lines over 24 h decreased, with an EMM of 28.31 in the furosemide group, and 30.12 in the torsemide group (p = 0.779). The severity of dyspnea, measured by the Borg scale, decreased over 24 h with an EMM of 3.58 points in the furosemide group, and 3.62 points in the torsemide group (p = 0.891). Pulmonary congestion, measured by the Killip-Kimball classification, minimized with an EMM of 0.42 points in the furosemide group, and 0.47 points in the torsemide group (p = 0.770). Daily urine output after 24 h of treatment reached an EMM of 3,559.67 mL in the furosemide group, and 2,734.89 mL in the torsemide group (p = 0.068).
Both furosemide and torsemide demonstrated comparable efficacy in the initial treatment of AHF, as assessed by laboratory, ultrasound, and clinical parameters.
静脉注射速尿和托拉塞米是急性心力衰竭（AHF）指南指导下药物治疗的基石。然而，关于每种药物优越性的证据仍存在争议。
这项前瞻性、开放标签、对照研究纳入了51例因AHF住院的成年患者。25例患者（49%）接受托拉塞米治疗，26例患者（51%）接受速尿治疗。主要终点是24小时尿钠水平的变化，用于评估利尿效果。次要结局包括肺部超声（LUS）B线、基于Borg量表的临床状态评估、Killip-Kimball分级和每日尿量。
治疗24小时后，速尿组尿钠水平估计边际均值（EMM）增加21.84 mmol/L，托拉塞米组增加0.97 mmol/L（p = 0.173）。24小时内B线数量减少，速尿组EMM为28.31，托拉塞米组为30.12（p = 0.779）。用Borg量表测量的呼吸困难严重程度在24小时内降低，速尿组EMM为3.58分，托拉塞米组为3.62分（p = 0.891）。用Killip-Kimball分级测量的肺淤血程度降低，速尿组EMM为0.42分，托拉塞米组为0.47分（p = 0.770）。治疗24小时后的每日尿量，速尿组EMM达到3559.67 mL，托拉塞米组为2734.89 mL（p = 0.068）。
根据实验室、超声和临床参数评估，速尿和托拉塞米在AHF初始治疗中疗效相当。
