Beneficial Effects of Torasemide on Systolic Wall Stress and Sympathetic Nervous Activity in Asymptomatic or Mildly Symptomatic Patients With Heart Failure: Comparison With Azosemide
Beneficial Effects of Torasemide on Systolic Wall Stress and Sympathetic Nervous Activity in Asymptomatic or Mildly Symptomatic Patients With Heart Failure: Comparison With Azosemide
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DOI：
10.1097/fjc.0b013e3181a717f7
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发表时间：
2009-06-01
影响因子：
3
通讯作者：
Murohara, Toyoaki
中科院分区：
文献类型：
--
作者：
Harada, Ken;Izawa, Hideo;Murohara, Toyoaki
长期应用袢利尿剂可激活神经体液机制，影响预后。既往研究显示托拉塞米（一种具有抗醛固酮能特性的袢利尿剂）可降低慢性心力衰竭（CHF）患者的死亡率。我们评价托拉塞米与阿佐塞米在CHF患者中的作用。患者接受托拉塞米（8 mg/d，n = 15）或阿佐塞米（60 mg/d，n = 15）口服利尿剂治疗3个月。然后将托拉塞米和阿佐塞米互换，患者再治疗3个月。托拉塞米治疗可显著降低左心室（LV）收缩期室壁应力（从259 95至232 +/- 80 kdyn/cm（2））和血浆醛固酮水平（从133 61至95 +/- 50 pg/mL），但与血浆去甲肾上腺素水平的变化无关。相比之下，血浆去甲肾上腺素水平显著增加（从370 +/- 170至481 +/- 247 pg/mL），而左室收缩期壁应力在阿佐塞米治疗后无变化。这项研究表明托拉塞米治疗降低了CHF患者的左室收缩期室壁应力，而没有激活交感神经系统。托拉塞米的抗醛固酮能特性可能有助于其良好的效果。
Loop diuretics could adversely influence prognosis due to activation of neurohumoral mechanism in the long term. Previous study showed torasemide, a loop diuretic with anti-aldosteronergic properties, was associated with lower mortality in patients with chronic heart failure (CHF). We evaluated the effects of torasemide, in comparison with azosemide, in patients with CHF. Patients received oral diuretic therapy with torasemide (8 mg/d, n = 15) or azosemide (60 mg/d, n = 15) for 3 months. Torasemide and azosemide were then switched, and the patients were treated for another 3 months. Torasemide treatment induced significant decreases in left ventricular (LV) systolic wall stress (from 259 95 to 232 +/- 80 kdyn/cm(2)) and the plasma level of aldosterone (from 133 61 to 95 +/- 50 pg/mL) and was not associated with a change in the plasma level of norepinephrine. In contrast, the plasma level of norepinephrine was significantly increased (from 370 +/- 170 to 481 +/- 247 pg/mL), whereas LV systolic wall stress was unchanged after azosemide treatment. This study indicates that torasemide treatment reduced LV systolic wall stress without activation of the sympathetic nervous system in patients with CHF. The anti-aldosteronergic properties of torasemide may contribute to its favorable effects.