Abstract 10403: Vasopressin V2 Receptor Antagonist Tolvaptan is Effective in Heart Failure Patients With Reduced Cardiac Systolic Function
Backgroud: Acute decompensated heart failure (ADHF) is a common and highly morbid cardiovascular disorder, and diuresis is a major therapy for the reduction of congestive symptoms. Most diuretics cause hyponatremia, which is a worsening factor of prognosis of ADHF patients. Carperitide has natriuretic and vasodilatation effects, and tolvaptan is a selective vasopressin V2 receptor antagonist and produces water excretion without changes in sodium excretion. The purpose of this study was to examine the efficacy of tolvaptan compared to carperitide based on the difference in left ventricular systolic function.
Methods and Results: One hundred and eight hospitalized ADHF patients were randomly assigned to tolvaptan or carperitide treatment groups. Baseline clinical characteristics were not difference between two groups. Blood pressure was significantly lower in the carperitide group than in the tolvaptan group just after treatment (P<0.05). Urine volume was significantly higher in the tolvaptan group (P<0.01), but volume of water intake was also higher in the tolvaptan group (P<0.01). We divided these patients into two groups based on left ventricular ejection fraction (EF) by echocardiography: preserved EF (≥50%, n=42) and reduced EF (<50%, n=66). There was no difference of daily urine volume between the tolvaptan group and the carperitide group in patients with preserved EF. However, daily urine volume in tolvaptan group was significantly higher than in the carperitide group in patients with reduced EF. In addition, serious adverse cardiac events such as worsening heart failure and hypotension requiring drug discontinuation were lower in the tolvaptan group than in the carperitide group in patients with reduced EF (P=0.027).
Conclusions: The present study reveals that tolvaptan is more effective especially in ADHF patients with reduced left ventricular systolic function compared to carperitide.
- © 2013 by American Heart Association, Inc.