Tolvaptan Improves Prognosis in Responders with Acute Decompensated Heart Failure by Reducing the Dose of Loop Diuretics
Tolvaptan Improves Prognosis in Responders with Acute Decompensated Heart Failure by Reducing the Dose of Loop Diuretics
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DOI：
10.1536/ihj.17-099
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发表时间：
2018-01-01
影响因子：
1.5
通讯作者：
Kinugawa, Koichiro
中科院分区：
文献类型：
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作者：
Nakamura, Makiko;Sunagawa, Osahiko;Kinugawa, Koichiro
在急性失代偿性心力衰竭(ADHF)患者中，对托伐普坦(TLV)的反应是否与预后有关尚不清楚。我们根据连续37例接受TLV治疗的ADHF患者对TLV的尿液反应和减少环状利尿剂的情况，选择了25名患者作为应答者。从100例未接受TLV治疗的ADHF患者中选择25例作为对照组，按年龄、血钠水平、血肌酐水平、血浆B型利钠肽(BNP)水平、收缩压、心率和环状利尿剂剂量进行倾向性评分匹配。主要结果被定义为死亡率和/或血液透析的复合终点。TLV治疗有效组给药环状利尿剂的剂量从68.8+/-26.2 mg减少到30.4+/-18.6 mg/d，无反应组环状利尿剂剂量增加。治疗组20个月无事件生存率显著高于对照组(95.8%vs68.4%，P=0.0406)。在COX比例风险分析中，TLV反应者、血浆BNP水平和估计的肾小球滤过率与事件显著相关。对TLV有反应的ADHF患者可能比未接受TLV治疗的倾向匹配的患者预后更好。在TLV反应者中，如果TLV治疗可以减少环状利尿剂的剂量，可能会改善患者的预后。
It is unknown whether a response to tolvaptan (TLV) is related to prognosis in patients with acute decompensated heart failure (ADHF). We selected 25 patients as responders by their urinary response to TLV and by reduction of loop diuretics from 37 consecutive ADHF patients treated with TLV. As a control group, we selected 25 patients from 100 consecutive ADHF patients who were not treated with TLV by propensity score matching for age, serum sodium level, serum creatinine level, plasma B-type natriuretic peptide (BNP) level, systolic blood pressure, heart rate, and dose of loop diuretics. The primary outcome was defined as a composite endpoint of mortality and/or hemodialysis. The amount of loop diuretics administered to responders was reduced by TLV from 68.8 +/- 26.2 mg to 30.4 +/- 18.6 mg of furosemide equivalents per day, whereas the loop diuretic dose administered to non-responders was increased. The event-free survival of the TLV responders during 20 months was significantly better than that of the control group (95.8% versus 68.4%, P = 0.0406). The TLV responders, plasma BNP level, and estimated glomerular filtration rate were significantly related to the events in the Cox proportional hazard analysis. Patients with ADHF who respond to TLV may have a better prognosis than propensity-matched patients not receiving TLV treatment. In TLV responders, it may be possible to improve the patient's prognosis if the dose of loop diuretics can be reduced with TLV therapy.