What is the clinical evidence from this study?

Study design: RCT. Population: Heart failure (n=40). Intervention: Torasemide vs. Furosemide. Primary outcome: Composite of improvement of NYHA class, improvement of at least 50 m during 6MWT, and decrease in fluid retention of at least 0.5 W (p=0.03).

January 7, 2020Open Access

Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial

Key Result

Torasemide improved the composite endpoint of NYHA class, 6-minute walk test distance, and fluid retention in 94% of heart failure patients compared to 58% treated with furosemide.

Study Design

Type

RCT (n=40)

Blinding

Open-label

Randomization

1:1

Multicenter

Yes

Structured PICO

Does torasemide improve symptoms and fluid retention compared to furosemide in patients with symptomatic heart failure?

Population

40 heart failure patients in NYHA II-IV class with a stable dose of furosemide, median age 66 years, 77.5% male.

Intervention

Torasemide at an equipotential dose (4:1 ratio to furosemide).

Comparator

Continuation of unchanged dose of furosemide.

Outcome

Composite of improvement of NYHA class, improvement of at least 50 m during 6-minute walk test (6MWT), and decrease in fluid retention of at least 0.5 W after 3-months follow-up.composite

In a pilot study of heart failure patients, switching to torasemide significantly improved a composite of NYHA class, 6MWT distance, and fluid retention compared to continuing furosemide at 3 months.

Main Result

Absolute Event Rate: 94% vs 58%

p-value: p=0.03

Limitations

Small sample size
Inability to assess the impact of torasemide and furosemide in different clinically relevant subgroups (e.g., elderly, chronic kidney disease, dilated cardiomyopathy)

Abstract

BACKGROUND: Recent reports suggest that torasemide might be more beneficial than furosemide in patients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide and furosemide on clinical outcomes in HF patients. METHODS: This study pilot consisted of data from the ongoing multicenter, randomized, unblinded endpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association (NYHA) II-IV class with a stable dose of furosemide were randomized to treatment with equipotential dose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment and control visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) and assessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint was a composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decrease in fluid retention of at least 0.5 W after 3-months follow-up. RESULTS: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up 7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients). The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively (p = 0.03). CONCLUSIONS: In HF patients treated with torasemide fluid overload and symptoms improved more than in the furosemide group. This positive effect occurred already within 3-month observation.

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