Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction
Abstract Aims Acute decompensated heart failure (ADHF) is generally treated by decongestion using diuretic therapy. However, the use of loop diuretics is associated with increased cardiac sympathetic nerve activity (CSNA). We aimed to evaluate the effect of adjunctive tolvaptan therapy on CSNA in AD...
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| Format: | Article |
| Language: | English |
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Wiley
2020-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12690 |
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| author | Shunsuke Tamaki Takahisa Yamada Takashi Morita Yoshio Furukawa Masato Kawasaki Atsushi Kikuchi Tsutomu Kawai Masahiro Seo Makoto Abe Jun Nakamura Kyoko Yamamoto Kiyomi Kayama Masatsugu Kawahira Kazuya Tanabe Kunpei Ueda Takanari Kimura Daisuke Sakamoto Yuto Tamura Takeshi Fujita Masatake Fukunami |
| author_facet | Shunsuke Tamaki Takahisa Yamada Takashi Morita Yoshio Furukawa Masato Kawasaki Atsushi Kikuchi Tsutomu Kawai Masahiro Seo Makoto Abe Jun Nakamura Kyoko Yamamoto Kiyomi Kayama Masatsugu Kawahira Kazuya Tanabe Kunpei Ueda Takanari Kimura Daisuke Sakamoto Yuto Tamura Takeshi Fujita Masatake Fukunami |
| author_sort | Shunsuke Tamaki |
| collection | DOAJ |
| description | Abstract Aims Acute decompensated heart failure (ADHF) is generally treated by decongestion using diuretic therapy. However, the use of loop diuretics is associated with increased cardiac sympathetic nerve activity (CSNA). We aimed to evaluate the effect of adjunctive tolvaptan therapy on CSNA in ADHF patients with preserved left ventricular ejection fraction (LVEF). Methods and results We enrolled 51 consecutive ADHF patients with LVEF ≥45%. Patients were randomly assigned to receive either tolvaptan add‐on (n = 25) or conventional diuretic therapy (n = 26). Cardiac iodine‐123 metaiodobenzylguanidine (MIBG) imaging was performed after stabilisation of heart failure symptoms, and the cardiac MIBG heart‐to‐mediastinum ratio (HMR) and washout rate (WR) were calculated. There were no significant differences in the body weight change and total urine volume during 2 days after randomisation or in the HMR on delayed image (HMR(d)) and WR between the tolvaptan and conventional groups. After stratification based on the median change in body weight, the patients with higher weight reduction had a significantly lower HMR(d) (P = 0.0128) and tended to have a higher WR (P = 0.0786) in the conventional group, whereas the cardiac MIBG imaging results were not influenced by body weight reduction in the tolvaptan group. Conclusions Adjunctive tolvaptan therapy may provide rapid decongestion without a harmful effect on CSNA in ADHF patients with preserved LVEF. |
| format | Article |
| id | doaj-art-4b63cb3349c040d0be7f6cc2e34b9db8 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-4b63cb3349c040d0be7f6cc2e34b9db82025-02-03T10:25:46ZengWileyESC Heart Failure2055-58222020-06-017393393710.1002/ehf2.12690Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fractionShunsuke Tamaki0Takahisa Yamada1Takashi Morita2Yoshio Furukawa3Masato Kawasaki4Atsushi Kikuchi5Tsutomu Kawai6Masahiro Seo7Makoto Abe8Jun Nakamura9Kyoko Yamamoto10Kiyomi Kayama11Masatsugu Kawahira12Kazuya Tanabe13Kunpei Ueda14Takanari Kimura15Daisuke Sakamoto16Yuto Tamura17Takeshi Fujita18Masatake Fukunami19Division of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanAbstract Aims Acute decompensated heart failure (ADHF) is generally treated by decongestion using diuretic therapy. However, the use of loop diuretics is associated with increased cardiac sympathetic nerve activity (CSNA). We aimed to evaluate the effect of adjunctive tolvaptan therapy on CSNA in ADHF patients with preserved left ventricular ejection fraction (LVEF). Methods and results We enrolled 51 consecutive ADHF patients with LVEF ≥45%. Patients were randomly assigned to receive either tolvaptan add‐on (n = 25) or conventional diuretic therapy (n = 26). Cardiac iodine‐123 metaiodobenzylguanidine (MIBG) imaging was performed after stabilisation of heart failure symptoms, and the cardiac MIBG heart‐to‐mediastinum ratio (HMR) and washout rate (WR) were calculated. There were no significant differences in the body weight change and total urine volume during 2 days after randomisation or in the HMR on delayed image (HMR(d)) and WR between the tolvaptan and conventional groups. After stratification based on the median change in body weight, the patients with higher weight reduction had a significantly lower HMR(d) (P = 0.0128) and tended to have a higher WR (P = 0.0786) in the conventional group, whereas the cardiac MIBG imaging results were not influenced by body weight reduction in the tolvaptan group. Conclusions Adjunctive tolvaptan therapy may provide rapid decongestion without a harmful effect on CSNA in ADHF patients with preserved LVEF.https://doi.org/10.1002/ehf2.12690Acute decompensated heart failureCongestionSympathetic nerve activityTolvaptan |
| spellingShingle | Shunsuke Tamaki Takahisa Yamada Takashi Morita Yoshio Furukawa Masato Kawasaki Atsushi Kikuchi Tsutomu Kawai Masahiro Seo Makoto Abe Jun Nakamura Kyoko Yamamoto Kiyomi Kayama Masatsugu Kawahira Kazuya Tanabe Kunpei Ueda Takanari Kimura Daisuke Sakamoto Yuto Tamura Takeshi Fujita Masatake Fukunami Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction ESC Heart Failure Acute decompensated heart failure Congestion Sympathetic nerve activity Tolvaptan |
| title | Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction |
| title_full | Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction |
| title_fullStr | Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction |
| title_full_unstemmed | Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction |
| title_short | Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction |
| title_sort | impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction |
| topic | Acute decompensated heart failure Congestion Sympathetic nerve activity Tolvaptan |
| url | https://doi.org/10.1002/ehf2.12690 |
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