Torasemide reduces dilated cardiomyopathy, complication of arrhythmia, and progression to heart failure

Abstract

ABSTRACT. The aim of this study was to analyze the incidence and types of arrhythmia and their relationship with the severity and prognosis of chronic heart failure (CHF) in patients with dilated cardiomyopathy (DCM), and to investigate the therapeutic effect of torasemide versus furosemide on CHF and incidence of arrhythmia. DCM patients with NYHA cardiac function II-IV were continuously monitored using a 24-h dynamic electrocardiogram (Holter), and arrhythmia incidence was analyzed by computer automatic analysis combined with manual assessment. In total, 125 participants were evenly divided into two groups: torasemide group which received 10 mg oral torasemide once daily) and regular anti-heart failure treatment (N = 65), and furosemide group which received torasemide (20 mg once daily orally) and regular antiheart failure treatment (N = 60). Another 60 normal healthy persons served as the normal control group. Incidence and severity of arrhythmia increased when degree of CHF was elevated. Size of left atrium was related to atrial fibrillation and size of left ventricle was related to malignant arrhythmia. At 3 months after treatment, cardiac function in both groups improved and incidence and severity of arrhythmia in both groups were reduced. However, left ventricular ejection fraction (LVEF) was higher in the torasemide group than in the furosemide group, while incidence of arrhythmia was lower in the torasemide group. Arrhythmias frequently occurred in patients with DCM and HF. Type of cardiac arrhythmia is closely related to ventricular enlargement and cardiac function grade. Torasemide is better for improving cardiac function to reduce arrhythmia and CHF compared to furosemide.

Inhibition of aldosterone synthase (CYP11B2) by torasemide prevents atrial fibrosis and atrial fibrillation in mice

“…This finding may be explained by the reported ability of torasemide to reduce trans-cardiac extraction of circulating aldosterone [47] and/or by the direct inhibition of aldosterone synthase activity. The data are in agreement with previous studies reporting that torasemide is not an MR antagonist [41] but reduces the expression of aldosterone synthase and fibrosis in the left ventricles of rats with dilated cardiomyopathy [35,48] as well as the incidence of atrial fibrillation in patients with dilated cardiomyopathy [49]. Importantly and consistently, the regulation e.g.…”

Short‐Term Efficacy and Safety of Torasemide and Furosemide in 366 Dogs with Degenerative Mitral Valve Disease: The TEST Study

“…It has been proposed that part of this mortality and morbidity benefit over furosemide might be related to the above‐mentioned pharmacokinetic differences and also to the pharmacodynamic properties of torasemide. Although not demonstrated in the dog, beyond its action on the thick loop of Henle, torasemide exerts vasodilating and antialdosterone effects, which are both beneficial in hypervolemic states . In vitro and in vivo studies have suggested that torasemide has antialdosterone properties, either by blocking the mineralocorticoid receptor binding of aldosterone (although recent data suggested that torasemide does not act as a mineralocorticoid receptor antagonist) or by inhibition of aldosterone synthase, with these effects being associated with prevention of atrial fibrosis and atrial fibrillation in mice as well as improvement of cardiac function and survival rate in rats with CHF .…”

“…Although not demonstrated in the dog, beyond its action on the thick loop of Henle, torasemide exerts vasodilating and antialdosterone effects, which are both beneficial in hypervolemic states. [33][34][35][36][37][38][39][40][41][42][43][44][45][46] In vitro and in vivo studies have suggested that torasemide has antialdosterone properties, either by blocking the mineralocorticoid receptor binding of aldosterone 43 (although recent data suggested that torasemide does not act as a mineralocorticoid receptor antagonist) 66 or by inhibition of aldosterone synthase, with these effects being associated with prevention of atrial fibrosis and atrial fibrillation in mice as well as improvement of cardiac function and survival rate in rats with CHF. 42,44,45 Whether or not the mechanism underlying the risk reduction of reaching the composite cardiac endpoint observed in the Torasemide group of the present trial is related to an antialdosterone effect remains to be determined by further studies.…”

“…Moreover, beyond its pure diuretic effect, torasemide has several beneficial actions that have been demonstrated in humans, animal models, and in vitro models. These include vasodilating properties as well as improvement of cardiac function and reduction of cardiac remodeling related, at least in part, to an antialdosterone effect . The TOrasemide In Congestive Heart Failure (TORIC) study demonstrated that torasemide had a more beneficial effect than furosemide and other diuretics on the mortality and morbidity of human patients suffering from chronic CHF .…”

“…These include vasodilating properties 33,34 as well as improvement of cardiac function and reduction of cardiac remodeling related, at least in part, to an antialdosterone effect. [35][36][37][38][39][40][41][42][43][44][45][46] The TOrasemide In Congestive Heart Failure (TORIC) study demonstrated that torasemide had a more beneficial effect than furosemide and other diuretics on the mortality and morbidity of human patients suffering from chronic CHF. 26 Limited data are currently available regarding the use of torasemide in veterinary cardiology, although some reports suggest its potential benefit in canine CHF.…”