Clinical efficacy of tolvaptan in acute decompensated heart failure patients with severe aortic stenosis and atrial fibrillation: a sub-analysis from the LOHAS registry.

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Heart and Vessels Pub Date : 2024-08-01 Epub Date: 2024-05-07 DOI:10.1007/s00380-024-02397-3
Tsutomu Murakami, Yusuke Watanabe, Norihito Nakamura, Makoto Natsumeda, Yohei Ohno, Gaku Nakazawa, Yuji Ikari, Akihisa Kataoka, Yosuke Nishihata, Kentaro Hayashida, Masanori Yamamoto, Jun Tanaka, Kentaro Jujo, Masaki Izumo, Kazuki Mizutani, Ken Kozuma
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引用次数: 0

Abstract

Background: Severe aortic valve stenosis (AS) and atrial fibrillation (AF) are risk factors of hemodynamic instability in heart failure (HF) management due to low cardiac output, respectively. Therefore, the treatment of HF due to severe AS complicated with AF is anticipated to be difficult. Tolvaptan, a vasopressin V2 receptor inhibitor, is effective in controlling acute decompensated heart failure (ADHF) with hemodynamic stability. However, its clinical efficacy against ADHF caused by AS with AF remains to be determined.

Methods: Clinical information (from September 2014 to December 2017) of 59 patients diagnosed with ADHF due to severe AS (20 patients with AF; 39 patients with sinus rhythm [SR]) was obtained from the LOHAS registry. The registry collected data from seven hospitals and assessed the short-term effects of tolvaptan in patients hospitalized for ADHF with severe AS. We attempted to identify clinical differences from baseline up to 4 days, comparing patients with AF (AF group) versus those with SR (SR group).

Results: There were no significant differences between the groups in age (83.7 ± 4.5 vs. 85.8 ± 6.9 years, respectively; p = 0.11) and aortic valve area (0.60 [0.46-0.73] vs. 0.56 [0.37-0.70] cm2, respectively; p = 0.50). However, left atrial volume was larger (104 [85-126] vs. 87 [64-103] mL, respectively; p < 0.01), whereas stroke volume was lower (51.6 ± 14.8 vs. 59.0 ± 18.7 mL, respectively; p = 0.08) in the AF group versus the SR group. Body weight decreased daily from baseline up to day 4 in both groups (from 55.4 to 53.2 kg [p < 0.01] and from 53.5 to 51.0 kg [p < 0.01], respectively) without change in heart rate. Notably, the systolic blood pressure decreased slightly in the AF group after 2 days of treatment with tolvaptan.

Conclusions: Short-term treatment with tolvaptan improved HF in patients hospitalized for severe AS, regardless of the presence of AF or SR. After achieving sufficient diuresis, a slight decrease in blood pressure was observed in the AF group, suggesting an appropriate timeframe for safe and effective use of tolvaptan.

Abstract Image

托伐普坦对伴有严重主动脉瓣狭窄和心房颤动的急性失代偿性心力衰竭患者的临床疗效:LOHAS登记的子分析。
背景:严重主动脉瓣狭窄(AS)和心房颤动(AF)分别是心输出量低导致心力衰竭(HF)治疗中血流动力学不稳定的危险因素。因此,严重的心瓣狭窄并发心房颤动导致的心力衰竭的治疗预计将十分困难。托伐普坦是一种血管加压素 V2 受体抑制剂,可有效控制急性失代偿性心力衰竭(ADHF)并保持血液动力学稳定。然而,它对强直性脊柱炎合并房颤引起的 ADHF 的临床疗效仍有待确定:从 LOHAS 登记处获取了 59 例确诊为严重 AS 引起的 ADHF 患者(20 例房颤患者;39 例窦性心律 [SR]患者)的临床资料(2014 年 9 月至 2017 年 12 月)。该登记处收集了七家医院的数据,并评估了托伐普坦对因重度强直性脊柱炎而住院的 ADHF 患者的短期疗效。我们试图比较房颤患者(房颤组)和SR患者(SR组),找出从基线到4天的临床差异:结果:两组患者在年龄(分别为 83.7 ± 4.5 岁 vs. 85.8 ± 6.9 岁;P = 0.11)和主动脉瓣面积(分别为 0.60 [0.46-0.73] cm2 vs. 0.56 [0.37-0.70] cm2;P = 0.50)方面无明显差异。然而,左心房容积更大(分别为 104 [85-126] mL vs. 87 [64-103] mL;P=0.50):无论是否存在房颤或SR,使用托伐普坦进行短期治疗都能改善因重度强直性脊柱炎住院患者的心房颤动。在实现充分利尿后,房颤组患者的血压略有下降,这表明托伐普坦的安全有效使用有一个合适的时间范围。
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来源期刊
Heart and Vessels
Heart and Vessels 医学-外周血管病
CiteScore
3.10
自引率
13.30%
发文量
211
审稿时长
2 months
期刊介绍: Heart and Vessels is an English-language journal that provides a forum of original ideas, excellent methods, and fascinating techniques on cardiovascular disease fields. All papers submitted for publication are evaluated only with regard to scientific quality and relevance to the heart and vessels. Contributions from those engaged in practical medicine, as well as from those involved in basic research, are welcomed.
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