Long-Term Tolvaptan Treatment in Refractory Heart Failure
Teruhiko Imamura1, Shintaro Kinugawa2, Toshihiro Muramatsu3
1Division of Cardiology, University of Chicago Medical Center Chicago, IL USA.
Circulation Reports
|March 11, 2021
Summary
Long-term tolvaptan therapy improved quality of life and renal function in patients with refractory heart failure (HF). This vasopressin receptor antagonist also reduced HF readmissions in estimated responders.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Tolvaptan, a vasopressin type-2 receptor antagonist, is used for short-term management of decompensated heart failure (HF).
- Evidence for its long-term efficacy in refractory HF remains conflicting.
- Identifying responders is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To evaluate the efficacy of 6-month tolvaptan add-on therapy in patients with refractory congestive heart failure (HF).
- To assess the impact of tolvaptan on quality of life, renal function, and HF readmissions.
Main Methods:
- Prospective, multi-center, open-label, randomized controlled trial (AQUA-TLV study).
- 29 patients with furosemide-refractory HF (≥60 mg/day) and urine osmolality ≥350 mOsm/L were randomized.
- Patients received either standard care or tolvaptan add-on therapy for 6 months.
Main Results:
- The tolvaptan group showed significant improvement in the Minnesota Living with Heart Failure Questionnaire score (P=0.030).
- Tolvaptan therapy led to reduced diuretic dosage (P=0.001) and improved serum creatinine (P=0.040).
- A trend towards improvement in hyponatremia was observed (P=0.12), with a lower HF readmission rate compared to controls.
Conclusions:
- Six-month tolvaptan therapy is effective in improving quality of life in patients with refractory HF.
- Tolvaptan enhances renal function and potentially reduces HF readmissions in selected patients.
- The study identified tolvaptan as a beneficial treatment option for estimated responders with refractory HF.
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