Relationship between the efficacy of tolvaptan and hemoglobin levels in acute decompensated heart failure

Objective: The purpose of this study is to investigate the factors that influence the effectiveness of tolvaptan treatment for acute decompensated heart failure. Methods and patients: This retrospective study included 102 patients with acute decompensated heart failure who were considered to require tolvaptan. We investigated whether tolvaptan administration was completed within 7 days or more and divided patients into two groups accordingly (responders, n = 35, non-responders, n = 67). Univariate, multivariate analysis and structural equation modeling were used to investigate the various clinical features involved in the success or failure of tolvaptan administration within 7 days. Among the investigation of various factors, changes in blood urea nitrogen, creatinine, and hemoglobin before and after tolvaptan administration were associated with the completion of tolvaptan administration. In order to proceed with further examination, we examined using a path diagram based on structural equation modeling. Results: It was found that low hemoglobin before treatment and high hemoglobin after treatment are related to the success of the completion of tolvaptan. Other factors were not related to the success of tolvaptan administration. The effectiveness of tolvaptan in pretreatment patients with low hemoglobin is especially important and hemoglobin level will be a valuable marker. Conclusion: This study showed that tolvaptan may be more effective at low hemoglobin in acute decompensated heart failure, which is generally difficult to treat. In that case, active use of tolvaptan is recommended.