Key result
Elevated arginine vasopressin levels were an independent predictor of adverse events (HR 1.218) in patients with stable heart failure and reduced ejection fraction.
Why the study?
Does loop diuretic therapy associate with elevated arginine vasopressin levels and predict adverse events in patients with stable heart failure and reduced LVEF?
Observational (n=63)
No
Does loop diuretic therapy associate with elevated arginine vasopressin levels and predict adverse events in patients with stable heart failure and reduced LVEF?
Elevated arginine vasopressin levels in heart failure patients receiving loop diuretics are an independent predictor of adverse events, suggesting loop diuretics may induce non-osmolar AVP release.
AVP elevation may flag higher risk in stable HFrEF on loop diuretics; hypothesis-generating and should not yet change practice.
Objective To investigate the association between arginine vasopressin (AVP) levels and loop diuretic (LD) therapy in patients with heart failure and to determine if AVP levels are a prognostic indicator of treatment failure. Methods Patients with stable heart failure and reduced (< 40%) left ventricular ejection fraction (LVEF) were divided into those treated with (LD) or without LD (NLD). The LD group was separated into subgroups of high (> 6.5 pg/dl) and low (≤ 6.5 pg/dl) AVP levels. The clinical and biochemical characteristics of the two groups were compared and the prognostic value of AVP levels in heart failure evaluated. Results Of the 63 patients enrolled into the study, 41 (65.1%) were in the LD group and 22 (34.9%) were in the NLD group. Despite no differences between groups in LVEF, creatinine clearance, or brain natriuretic peptide, the LD group had significantly higher AVP levels compared with the NLD group. A Cox proportional-hazards model showed that AVP was an independent predictor of adverse events. In addition, the elevation in AVP in the LD group was inversely correlated with an increase in free water clearance but not serum osmolality and was related to poor outcome. Conclusions Elevated AVP levels in patients with heart failure who received LD therapy were associated with a poor prognosis. Loop diuretics may induce non-osmolar AVP release, which can worsen heart failure.
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Kitada et al. (2016) conducted an observational in Stable heart failure with reduced left ventricular ejection fraction (n=63). Elevated arginine vasopressin (AVP) levels vs. Low AVP levels was evaluated on Adverse events (cardiovascular death, cardiopulmonary resuscitation due to ventricular tachycardia or fibrillation, and hospitalization for heart failure) (HR 1.218, 95% CI 1.08-1.38, p=0.002). Elevated arginine vasopressin levels were an independent predictor of adverse events (HR 1.218) in patients with stable heart failure and reduced ejection fraction.
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