Effects of Long-Acting Loop Diuretics in Heart Failure With Reduced Ejection Fraction Patients With Cardiac
Masahiko Asami1, Jiro Aoki, Shuzou Tanimoto
1Division of Cardiology, Mitsui Memorial Hospital.
Insights
Long-acting loop diuretics (LLD) show comparable outcomes to short-acting diuretics for heart failure (HF) and arrhythmias in patients with reduced ejection fraction (HFrEF) receiving cardiac resynchronization therapy (CRT). Further research is warranted.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Limited data exists on long-acting loop diuretics (LLD) in heart failure with reduced ejection fraction (HFrEF) patients with cardiac resynchronization therapy (CRT).
- Understanding diuretic impact is crucial for managing HF and arrhythmias in this population.
Purpose of the Study:
- To evaluate the impact of LLD versus short-acting loop diuretics on HF and arrhythmia treatment outcomes in HFrEF patients with CRT devices.
Main Methods:
- A prospective, single-blind, randomized crossover study involving 21 HFrEF patients with CRT.
- Patients were assigned to receive furosemide then azosemide, or vice versa, for 6-month treatment periods.
- Primary endpoints included fluid index and thoracic impedance measured by CRT.
Main Results:
- No statistically significant differences were observed in fluid index or thoracic impedance between LLD and short-acting diuretic arms.
- Clinical outcomes for heart failure and CRT-derived parameters were comparable between the two medication regimens.
Conclusions:
- LLD may offer comparable efficacy to short-acting loop diuretics for managing HF and associated arrhythmias in HFrEF patients post-CRT implantation.
- These findings suggest LLD as a potential alternative in HF management for CRT patients.
Abstract:
There have been no reports evaluating the impact of long-acting loop diuretics (LLD) on the outcome of heart failure (HF) and arrhythmia treatment in HF with reduced ejection fraction (HFrEF) patients implanted with a cardiac resynchronization therapy (CRT) device.This was a prospective, single-blind, randomized crossover study. We allocated 21 consecutive CRT implanted patients into 2 groups. The furosemide group received furosemide as a first treatment and azosemide as a second treatment. The azosemide group received this treatment in the reverse order. The first treatment was given to each group for 6 months and the second treatment continued for an additional 6 months. We combined the data of each medication regimen in each group and analyzed it at baseline, 6 months, and 1 year. The primary endpoints were the variation of fluid index and thoracic impedance measured by CRT at 6 months.The baseline characteristics were similar for both groups. The difference in the primary endpoints was not statistically significant between the 2 medication arms (fluid index: -29.6 ± 64.4 versus 16.2 ± 48.2; P = 0.22, thoracic impedance: -0.49 ± 17.8 versus 2.45 ± 12.5; P = 0.56). Likewise, the clinical outcome of HF and the CRT derived parameters in both arms were comparable.HFrEF patients taking LLD after CRT implantation might be comparable to those taking short-acting loop diuretics in the treatment of HF and HF-associated arrhythmias.
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Heart Failure VI: Adjunct Therapies
01:30Heart Failure V: Medical Management
01:26Heart Failure Drugs: Inotropic Agents
01:22Heart Failure Drugs: β-Blockers