Short-term effects of low-dose tolvaptan in acute decompensated heart failure patients with severe aortic stenosis: The LOHAS registry

Watanabe, Yusuke; Nara, Yugo; Hioki, Hirofumi; Kawashima, Hideyuki; Kataoka, Akihisa; Nakashima, Mitsuyoshi; Nishihata, Yosuke; Hayashida, Kentaro; Yamamoto, Masanori; Tanaka, Jun; Mizutani, Kazuki; Jujo, Kentaro; Nakazawa, Gaku; Izumo, Masaki; Kozuma, Ken

doi:10.1016/j.ijcard.2020.02.017

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Among other measures targeting fluid retention, tolvaptan, an oral selective V2 receptor antagonist, promoting free water excretion in the urine without affecting hemodynamics and renal function, proved safety and effectiveness in small pilot studies including subjects with acute advanced AS [ 23 ]. Vasodilators may relief dyspnea but caution is needed as they can reduce blood pressure and coronary perfusion.…”

Section: Medical Therapymentioning

confidence: 99%

Acute advanced aortic stenosis

et al. 2023

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Acute decompensation often represents the onset of symptoms associated with severe degenerative aortic stenosis (AS) and usually complicates the clinical course of the disease with a dismal impact on survival and quality of life. Several factors may derange the faint balance between left ventricular preload and afterload and precipitate the occurrence of symptoms and signs of acute heart failure (HF). A standardized approach for the management of this condition is currently lacking. Medical therapy finds very limited application in this setting, as drugs usually indicated for the control of acute HF might worsen hemodynamics in the presence of AS. Urgent aortic valve replacement is usually performed by transcatheter than surgical approach whereas, over the last decades, percutaneous balloon valvuloplasty gained renewed space as bridge to definitive therapy. This review focuses on the pathophysiological aspects of acute advanced AS and summarizes current evidence on its management.

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Section: Medical Therapymentioning

confidence: 99%

Acute advanced aortic stenosis

et al. 2023

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“…Tolvaptan, an oral selective V2 receptor antagonist, has been proved safe and efficacious in causing net volume depletion in cases of acute HF and severe AS. 129 , 130 Inotropes and vasopressors, traditionally used to treat acute HF by increasing tissue perfusion, are being progressively limited due to side effects such as arrhythmias and myocardial injury. 131 A calcium stabilizer by the name of levosimendan, having inotropic and vasodilator properties, has been shown to improve the symptoms and haemodynamic profile of patients in acute HF with severe AS.…”

Section: Management Of Amyloidosis and Underlying Aortic Stenosismentioning

confidence: 99%

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Jaiswal,

Agrawal,

Khulbe

et al. 2023

European Heart Journal Open

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Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded proteins infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin-cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4 to 16% of cases, especially in those undergoing transcatheter aortic valve replacement. Diagnostic work-up for cardiac amyloidosis in patients with aortic stenosis is based on a multiparametric approach considering clinical assessment, electrocardiogram, haematologic tests, basic and advanced echocardiography, cardiac magnetic resonance, technetium labeled cardiac scintigraphy like 99mTc-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, and 99mTc-hydroxymethylenediphosphonate. However, a biopsy is the traditional gold standard for diagnosis. The prognosis of patients with coexisting cardiac amyloidosis and aortic stenosis is still under evaluation. The combination of these two pathologies worsens the prognosis. Regarding treatment, mortality is reduced in patients with cardiac amyloidosis and severe aortic stenosis after undergoing transcatheter aortic valve replacement. Further studies are needed to confirm these findings and to understand whether the diagnosis of cardiac amyloidosis could affect therapeutic strategies. The aim of this review is to critically expose the current state-of-art regarding the association of cardiac amyloidosis with aortic stenosis, from pathophysiology to treatment.

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“…AS commonly leads to acute decompensated HF due to progressive obstruction of the aortic valve, at which time prompt management is required to manage symptoms, maintain cardiac output, and improve prognosis. 19,20 The use of loop diuretics in the management of HF is extremely common. However, there is controversy surrounding their use in HF and hypertension in patients with AS.…”

Section: Diureticsmentioning

confidence: 99%

Antihypertensive therapy in patients with moderate to severe aortic stenosis

Hussein¹,

Harvey²,

Bueckert³

2021

The Nurse Practitioner

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Patients with aortic stenosis are at risk for developing hypertension. The selection of antihypertensives is a topic of debate due to a lack of consensus regarding their safety. This article provides an overview of antihypertensives used in patients with aortic stenosis, focusing on renin-angiotensin system inhibitors, beta-blockers, diuretics, and vasodilators.Antihypertensive therapy in patients with moderate to severe aortic stenosis sfam_photo

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Short-term effects of low-dose tolvaptan in acute decompensated heart failure patients with severe aortic stenosis: The LOHAS registry

Cited by 5 publications

References 30 publications

Acute advanced aortic stenosis

Acute advanced aortic stenosis

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Antihypertensive therapy in patients with moderate to severe aortic stenosis

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