Abstract 3396: A Randomized, Open-label, Crossover Pilot Study Comparing The Effects Of A Loop Diuretic With Antialdosteronergic Properties Versus A Pure Loop Diuretic On Activation Of Sympathetic Nerve System In Mildly Symptomatic Patients With Chronic Heart Failure
Background: Although a lower mortality among patients with chronic heart failure treated with torasemide, a loop diuretic with antialdosteronergic properties, compared to other diuretics have been reported, the mechanisms of the beneficial effect of torasemide remain to be fully elucidated
Objectives: To determine the effect of torasemide, compared with azosemide, a pure loop diuretic, on activation of sympathetic nerve system in mildly symptomatic patients with chronic heart failure (CHF).
Methods: Thirty patients with New York Heart Association (NYHA) functional class I or II received diuretic therapy with 4 mg/day oral torasemide (n = 15) or 30 mg/day oral azosemide (n = 15), in addition to their existing therapy for 3 months. We changed torasemide to azosemide or azosemide to torasemide and followed for another 3 months. We evaluated echocardiographic findings and plasma levels of neurohumoral factors at baseline and every 3-month. The study protocol was approved by the Institutional Review Board and written informed consent was obtained from all patients.
RESULT: Torasemide significantly decreased left ventlicular end-diastolic diameter (LVDd) from 53.8 +/− 8.2 mm to 50.2 +/− 8.9 mm (p< 0.01), and plasma levels of aldosterone from 131 +/− 64 pg/ml to 94 +/− 54 pg/ml (p< 0.05). Torasemide affects neither plasma levels of norepinephrine nor brain natriuretic peptide. Conversely, azosemide significantly increased plasma levels of norepinephrine from 398 +/− 239 pg/ml to 513 ±/− 284 pg/ml (p< 0.05), without significant decrease in LVDd.
CONCLUSION: This randomized, open-label, crossover study indicates that torasemide treatment can ameliorate left ventricular remodeling without activation of sympathetic nerve system in patients with CHF as compared to azosemide. Antialdosteronergic properties could play a role partly in favorable effects of torasemide.