Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis With Low Dose Tolvaptan in Elderly Patients

Takasu, Kiyoshi; Miyazaki, Tatsuya; Negoro, Kanako; Yatsu, Shoichiro; Shimizu, Megumi; Murata, Azusa; Kato, Takao; Suda, Shoko; Hiki, Masaru; Kasai, Takatoshi; Miyauchi, Katsumi; Daida, Hiroyuki

doi:10.1536/ihj.16-226

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…Takasu et al reported that low-dose TLV therapy for elderly AHF patients with severe aortic stenosis resulted in decongestion without causing hemodynamic instability. 28 Their patients were given a lower dose of TLV (4.8 + 1.8 mg daily) than in the present study (7.2 + 1.8 mg daily).…”

Section: Administration Of Low-dose Tlvmentioning

confidence: 50%

Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure

Sato

Uzui

Mukai

et al. 2019

J Cardiovasc Pharmacol Ther

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Background: The oral vasopressin-2 receptor antagonist, tolvaptan, causes aquaresis and improves symptoms in patients with congestive heart failure. However, few studies have explored the effect of tolvaptan in acute heart failure (AHF) patients ≥90 years old. Methods: This study enrolled 106 AHF patients treated with tolvaptan added to standard therapy. The subjects were divided into 2 groups: ≥90-year-old patients (over-90 group, mean 92 ± 2 years, n = 45) and <90-year-old patients (under-90 group, mean 76 ± 11 years, n = 61). Patients’ characteristics were assessed, and efficacy and safety were compared between the 2 groups. Results: The over-90 group had a lower proportion of male patients, lower body weight, and higher ejection fraction. The under-90 group had significantly higher prevalence of ischemic heart disease and diabetes mellitus. There were no significant differences between the 2 groups in total urine volume at 24 and 48 hours (1934 ± 983 mL vs 1816 ± 1028 mL, P = 0.58 and 3806 ± 1444 mL vs 4078 ± 1851 mL, P=0.47, respectively), the mean change in body weight (−3.0 ± 2.7 kg vs −2.6 ± 2.6 kg, P = 0.50), improvement of congestive symptoms, changes in serum sodium and creatinine levels, the incidences of hypernatremia (n = 0, 0% vs n = 1, 1.6%, P = 0.63), and worsening renal function (n = 9, 20% vs n = 17, 28%, P = 0.48). Conclusion: The efficacy and safety of tolvaptan in AHF patients aged more than 90 years were comparable to those of <90 years old. Tolvaptan provides a complementary therapeutic option for AHF patients aged more than 90 years.

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Section: Administration Of Low-dose Tlvmentioning

confidence: 50%

Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure

Sato

Uzui

Mukai

et al. 2019

J Cardiovasc Pharmacol Ther

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“…26) In terms of increasing serum sodium levels, the vasopressin V2 receptor antagonist tolvaptan is the reasonable option since it acts directly against ADHF-associated enhanced AVP secretion. [27][28][29] Indeed, in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST), tolvaptan significantly increased the serum sodium concentration in hyponatremic patients hospitalized with ADHF. 30) In a post hoc analysis of the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure trial in which patients hospitalized for ADHF were randomized to placebo or one of 3 tolvaptan doses to investigate its effects on 60-day mortality, hyponatremic patients with a serum sodium improvement (!2 mmol/L increased from admission to discharge) had better 60-day mortality rates compared to those showing no improvement, 31) suggesting the therapeutic potential of tolvaptan on admission hyponatremia in patients hospitalized with ADHF.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Serum Sodium Level Within the Low-Normal Range on Admission and Long-Term Clinical Outcomes in Patients with Acute Decompensated Heart Failure

et al. 2018

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Although hyponatremia during hospitalization for acute decompensated heart failure (ADHF) is reportedly related with poor prognosis, the available data regarding the impact of serum sodium level within the low-normal range at admission on clinical events in patients with ADHF is limited.We studied eligible patients admitted to our institution in 2007-2011. All the patients were categorized into 3 groups according to the admission serum sodium levels of < 135 mmol/L (hyponatremia), ≥ 135 and < 140 mmol/L (low-normal range), or ≥ 140 mmol/L (normal range). The association between admission serum sodium levels and long-term clinical events, a composite of all-cause deaths and re-hospitalizations for ADHF, was assessed by multivariable Cox proportional analysis.Of the 584 eligible patients, 208 (35.6%) were in the low-normal range and 99 (16.9%) had hyponatremia on admission. On multivariable analysis, compared with those with a sodium level ≥ 140 mmol/L, patients with hyponatremia were at increased risk for clinical events (hazard ratio [HR], 1.53; P = 0.041), whereas the HR of those in the low-normal range was attenuated and insignificant (HR, 1.08; P = 0.625). However, the HR of each category increased significantly as sodium level decreased (P value for HR trend, 0.024). In addition, when serum sodium level was treated as a continuous variable, the lower the serum sodium level, the greater the risk of clinical events (P = 0.012). The cut-off value of serum sodium level to predict mortality was < 138 mmol/L.In conclusion, a low serum sodium level on admission for ADHF, even if low-normal, can increase the risk of long-term mortality and/or re-hospitalization for ADHF.

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“…Tolvaptan is an oral selective V2 receptor antagonist that increases net volume loss in patients with HF without adversely affecting hemodynamics [9,12,15,16]. Previous pilot studies demonstrated the safety and efficacy of tolvaptan treatment in patients with HF and severe AS [17,18]; however, these studies did not fully clarify its safety and efficacy based on a prospective multicenter design. The present LOHAS registry showed comparative results with these previous reports, demonstrating increased urine output, reduced body weight, and improved symptoms and serum BNP levels without affecting blood pressure, heart rate, and renal function even in elderly patients with severe AS.…”

Section: Discussionmentioning

confidence: 99%

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

Watanabe

Nara

Hioki

et al. 2020

International Journal of Cardiology

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Background: Tolvaptan exerts potent diuretic effects in heart failure patients without hemodynamic instability. Nonetheless, its clinical efficacy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) remains unclear. This study aimed to evaluate the short-term effects of tolvaptan in ADHF patients with severe AS. Methods: The LOw-Dose Tolvaptan (7.5 mg) in Decompensated Heart Failure Patients with Severe Aortic Stenosis (LOHAS) registry is a multicenter (7 centers) prospective registry that assessed the short-term effects of tolvaptan in subjects hospitalized for ADHF with severe AS. A total of 59 subjects were enrolled between September 2014 and December 2017. The primary endpoints were changes in body weight and fluid balance measured daily from baseline up to 4 days. Results: The median [interquartile range] patient age and aortic valve area were 85.0 [81.0-89.0] years and 0.58 [0.42-0.74] cm 2 , respectively. Body weight continuously decreased, and fluid balance was maintained from baseline to day 4 (p b 0.001, p = 0.194, respectively). Median serum B-type natriuretic peptide concentration significantly decreased from 910.5 to 740.0 pg/mL by day 4 (p = 0.002). However, systolic blood pressure and heart rate were non-significantly changed (p = 0.250, p = 0.656, respectively). Hypernatremia (N150 mEq/L) and worsening renal function occurred in 2 (3.4%) and 4 (6.8%) patients, respectively. Conclusions: Short-term treatment with low-dose tolvaptan is safe and effective, providing stable hemodynamic parameters in patients with ADHF and severe AS.

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Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis With Low Dose Tolvaptan in Elderly Patients

Cited by 10 publications

References 30 publications

Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure

Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure

Relationship Between Serum Sodium Level Within the Low-Normal Range on Admission and Long-Term Clinical Outcomes in Patients with Acute Decompensated Heart Failure

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

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