Key result
Tolvaptan significantly increased urine volume from 896 to 1322 mL/day without causing significant blood pressure decrease or worsening of aortic valve flow in patients with severe aortic stenosis.
Why the study?
Heart failure in severe AS before aortic valve intervention has a poor prognosis, and while loop diuretics risk critical hypotension, tolvaptan may help maintain hemodynamics.
Does tolvaptan safely increase urine volume and maintain hemodynamics in patients with heart failure caused by severe aortic stenosis?
Observational (n=10)
No
Does tolvaptan safely increase urine volume and maintain hemodynamics in patients with heart failure caused by severe aortic stenosis?
Tolvaptan safely increases urine volume without compromising hemodynamics or kidney function in patients with heart failure due to severe aortic stenosis.
Tolvaptan was associated with symptom relief in severe AS heart failure; leaves open confirmation by prospective trials before practice change.
BACKGROUND: Heart failure in severe aortic stenosis (AS) before aortic valve has a poor prognosis with high risk. Although the overuse of loop diuretics may induce hypovolemia, cardiac output reduction, and critical hypotension in severe AS, tolvaptan is characterized by its ability to help maintain hemodynamics and seems to be appropriate for use in heart failure caused by AS. Therefore, we retrospectively examined the effects and safety of tolvaptan use in patients with heart failure caused by severe AS. METHODS AND RESULTS: Ten patients with heart failure caused by severe AS were enrolled. Tolvaptan administration did not cause blood pressure decrease significantly, whereas urine volume increased significantly from 896±318 to 1322±502 mL/day (P<0.05). Although there was no statistical significance, functional classes tended to be improved. Blood tests indicated no worsening of kidney function and N-terminal pro-brain natriuretic peptide levels after the use of tolvaptan. Echocardiography also showed no hypovolemia and no worsening of aortic valve flow (18.3±3.8 to 15.5±5.5 cm/s, n.s). CONCLUSIONS: Tolvaptan use in AS patients with heart failure is effective and safe before aortic valve intervention.
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Shimozono et al. (2020) conducted an observational in Heart failure caused by severe aortic stenosis (n=10). Tolvaptan vs. Baseline (pre-tolvaptan) was evaluated on Urine volume (mL/day) (p=<0.05). Tolvaptan significantly increased urine volume from 896 to 1322 mL/day without causing significant blood pressure decrease or worsening of aortic valve flow in patients with severe aortic stenosis.
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