Investigating a biomarker‐driven approach to target collagen turnover in diabetic heart failure with preserved ejection fraction patients. Effect of torasemide versus furosemide on serum C‐terminal propeptide of procollagen type I (DROP‐PIP trial)

Abstract

In this hypothesis-generating, mechanistic trial in stable HFpEF patients with T2DM, neither long-term administration of torasemide nor furosemide was associated with a significant effect on myocardial fibrosis, as assessed by serum PIP. Further studies are urgently needed in this field. More specific diuretic and anti-fibrotic treatment strategies in T2DM and/or HFpEF are warranted.

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…Additional diagnostic criteria for HFpEF have been published, including one scoring system, but they differ in echocardiographic cut‐off values, the role of comorbidities, the inclusion of biomarkers, the role of invasive haemodynamic assessment, and the role of exercise stress testing , 4 , 6–8 . Understanding of the pathophysiology of HFpEF has advanced, 9–13 diagnostic options have evolved, 14–17 and this novel information needs to be integrated into a new comprehensive diagnostic algorithm for suspected HFpEF.…”

“…4 Additional diagnostic criteria for HFpEF have been published, including one scoring system, 5 but they differ in echocardiographic cut-off values, the role of comorbidities, the inclusion of biomarkers, the role of invasive haemodynamic assessment, and the role of exercise stress testing. 3,4,[6][7][8] Understanding of the pathophysiology of HFpEF has advanced, [9][10][11][12][13] diagnostic options have evolved, [14][15][16][17] and this novel information needs to be integrated into a new comprehensive diagnostic algorithm for suspected HFpEF. A writing committee initiated by the HFA of the ESC has therefore produced an updated consensus recommendation-the HFA-PEFF diagnostic algorithm (Figure 1). Its key elements are (i) the concept that identification of HFpEF involves all levels of care, including general practitioners, internists, general cardiologists, HF specialists, and invasive cardiologists; (ii) a stepwise diagnostic approach from initial clinical assessment to more specialized tests will therefore be useful; (iii) the diagnosis is not always straightforward, so the integration of distinct parameters from complementary diagnostic domains into a new diagnostic score is recommended; (iv) for the subset of patients with an inconclusive score, definitive diagnosis (or exclusion) will require invasive haemodynamics and/or non-invasive or invasive exercise stress tests; and (v) underlying pathophysiological alterations [such as chronotropic…”

Torasemide versus furosemide in treatment of heart failure: A systematic review and meta‐analysis of randomized controlled trials

“…A total of 18 RCTs with 1598 subjects were included for reviewing. Finally, 14 RCTs were considered for the quantitative synthesis while four were included for qualitative synthesis . (Figure ).…”

“…The mean weight varied from 58 to 86.7 kg in the torasemide group and from 59 to 84.6 kg in the furosemide group. Twelve studies used oral administration route, while four studies used IV for drug administration . One study used both routes: oral and IV .…”

“…While Vargo et al reported a more rapid absorption and higher bioavailability of torasemide compared to furosemide. Trippel et al concluded that torasemide has no effects more than furosemide in improving functional capacity, diastolic function, quality of life, or neuroendocrine activation.…”