Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow and normal-flow severe aortic stenosis.

Authors:
Miho Mitsui
Miho Mitsui
Teikyo University School of Medicine
Akihisa Kataoka
Akihisa Kataoka
Chiba University Graduate School of Medicine
Japan
Yugo Nara
Yugo Nara
Teikyo University School of Medicine
Fukuko Nagura
Fukuko Nagura
Teikyo University School of Medicine
Itabashi | Japan
Hideyuki Kawashima
Hideyuki Kawashima
Nihon University School of Dentistry
Japan
Hirofumi Hioki
Hirofumi Hioki
Shinshu University School of Medicine
Makoto Nakashima
Makoto Nakashima
Graduate School of Engineering
Japan
Yusuke Watanabe
Yusuke Watanabe
Saitama Medical University
Japan

Heart Vessels 2019 Apr 16. Epub 2019 Apr 16.

Division of Cardiology, Department of Internal Medicine, Teikyo University, 2-11-1 Kaga, Tokyo, 173-8606, Japan.

Conventional diuretic therapy for low-flow (LF) severe aortic stenosis (SAS) often has an inadequate effect or causes hemodynamic instability. Tolvaptan is used for acute heart failure in addition to conventional diuretics, and it does not cause intravascular dehydration. This study aimed to retrospectively investigate the safety and efficacy of tolvaptan in the acute phase in 56 consecutive patients with SAS and compared LF-SAS with normal-flow (NF) SAS. The primary endpoints were adverse clinical events (death, worsening heart failure, worsening renal failure, fatal arrhythmia, cardiogenic or hypovolemic shock, and use of inotropic agents) and the volume of urine within 48 h of tolvaptan administration. Among 56 patients, 16 had LF-SAS (29%), and 40 had NF-SAS (71%). Severe adverse clinical events were not observed 48 h after tolvaptan administration. In both groups, the urine volume significantly increased after tolvaptan administration in comparison to 24 h before tolvaptan administration (both, p < 0.01). There were no changes in the urine volume during the initial 24 and 48 h. In the LF-SAS group, tolvaptan resulted in a significant decrease in fluid balance during the initial 24 and 48 h compared to 24 h before tolvaptan administration (p < 0.05). Adding tolvaptan to conventional treatment is safe and effective without renal dysfunction and hypotension in patients with SAS, including those with LF.

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http://link.springer.com/10.1007/s00380-019-01411-3
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http://dx.doi.org/10.1007/s00380-019-01411-3DOI Listing
April 2019
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