Key result
Low-dose tolvaptan significantly decreased body weight (p<0.001) and median BNP from 910.5 to 740.0 pg/mL (p=0.002) over 4 days in patients with acute decompensated heart failure and severe AS.
Why the study?
The clinical efficacy of tolvaptan for acute decompensated heart failure due to severe aortic stenosis remains unclear.
Does low-dose tolvaptan improve body weight and fluid balance in patients hospitalized for acute decompensated heart failure with severe aortic stenosis?
Observational (n=59)
Yes
Does low-dose tolvaptan improve body weight and fluid balance in patients hospitalized for acute decompensated heart failure with severe aortic stenosis?
Low-dose tolvaptan safely reduces body weight and BNP without causing hemodynamic instability in patients with acute decompensated heart failure and severe aortic stenosis.
May support cautious decongestion in acute HF with severe AS; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Tolvaptan exerts potent diuretic effects in heart failure patients without hemodynamic instability. Nonetheless, its clinical efficacy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) remains unclear. This study aimed to evaluate the short-term effects of tolvaptan in ADHF patients with severe AS. METHODS: The LOw-Dose Tolvaptan (7.5 mg) in Decompensated Heart Failure Patients with Severe Aortic Stenosis (LOHAS) registry is a multicenter (7 centers) prospective registry that assessed the short-term effects of tolvaptan in subjects hospitalized for ADHF with severe AS. A total of 59 subjects were enrolled between September 2014 and December 2017. The primary endpoints were changes in body weight and fluid balance measured daily from baseline up to 4 days. Body weight continuously decreased, and fluid balance was maintained from baseline to day 4 (p < 0.001, p = 0.194, respectively). Median serum B-type natriuretic peptide concentration significantly decreased from 910.5 to 740.0 pg/mL by day 4 (p = 0.002). However, systolic blood pressure and heart rate were non-significantly changed (p = 0.250, p = 0.656, respectively). Hypernatremia (>150 mEq/L) and worsening renal function occurred in 2 (3.4%) and 4 (6.8%) patients, respectively. CONCLUSIONS: Short-term treatment with low-dose tolvaptan is safe and effective, providing stable hemodynamic parameters in patients with ADHF and severe AS.
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Watanabe et al. (2020) conducted an observational in Acute decompensated heart failure with severe aortic stenosis (n=59). Low-dose tolvaptan was evaluated on Changes in body weight and fluid balance measured daily from baseline up to 4 days (p=<0.001). Low-dose tolvaptan significantly decreased body weight (p<0.001) and median BNP from 910.5 to 740.0 pg/mL (p=0.002) over 4 days in patients with acute decompensated heart failure and severe AS.
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