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April 18, 2026Clinical CardiologyOpen Access

Loop diuretic use in severe AS links to ~100% higher mortality, likely reflecting confounding by indication.

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Why the study?

Does loop diuretic use increase mortality in patients with severe aortic stenosis?

Population

Patients with severe aortic stenosis (AS)

Design

Editorial

Key result

Loop diuretic use in severe aortic stenosis was associated with mortality (HR ≈ 2.0), but this likely reflects confounding by indication and disease severity rather than a direct effect.

Authors

ITIbadullah TahirHSHunain Shahbaz

Discussion

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Overview

Single-center bias precludes practice change using loop diuretic mortality data in severe AS; leaves open optimal agent pending RCTs.

Key Points

  • The aim is to evaluate the role of loop diuretics in assessing disease severity and mortality risk in severe aortic stenosis patients.
  • Retrospective single-center design study
  • Comparison of loop diuretic users with respective cohorts
  • Analysis of hemodynamic indices and mortality hazard ratios
  • LDT users showed greater symptoms of aortic stenosis and higher surgical risk scores
  • The statistical significance of torsemide dose diminished after adjusting for confounding factors
  • Diuretic use was more indicative of clinical severity rather than a direct mortality risk factor

Structured PICO

Does loop diuretic use increase mortality in patients with severe aortic stenosis?

P
Population
Patients with severe aortic stenosis (AS)
I
Intervention
Loop diuretics (specifically torsemide)
O
Outcome
Mortalityhard clinical

Main Result

Effect estimate: HR ≈ 2.0

Loop diuretic use in severe aortic stenosis serves as a marker of disease severity and congestion rather than an independent driver of mortality.

Limitations

  • Retrospective single-center design
  • Confounding by indication
  • Lack of exhaustive variable adjustment (frailty, comorbidity burden, longitudinal volume status, and postoperative therapy)
  • Limited generalizability due to use of only torasemide and specific patient populations
  • Retrospective single-center design of the original study
  • Lack of exhaustive variable adjustment (frailty, comorbidity burden, longitudinal volume status, postoperative therapy)
  • Limited generalizability (only torasemide used)

Cite This Study

Tahir et al. (2026) conducted a letter in Severe aortic stenosis. Loop diuretics was evaluated on Mortality (HR ≈ 2.0). Loop diuretic use in severe aortic stenosis was associated with mortality (HR ≈ 2.0), but this likely reflects confounding by indication and disease severity rather than a direct effect.

synapsesocial.com/papers/69e3205140886becb653f702https://doi.org/10.1002/clc.70306
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