Abstract 12294: Right Ventricular Dysfunction Plays an Important Role in Predicting Non-Response to Tolvaptan Treatment in Patients With Heart Failure With Reduced Ejection Fraction: Strain Echocardiography Study
Background: Tolvaptan (TLV), a newly-developed vasopressin type 2 receptor antagonist, has a unique feature of diuresis, but the response to this drug can be unpredictable. This retrospective study used a novel speckle tracking echocardiography to examine the predictability of TLV effectiveness in patients with heart failure (HF). Right ventricular (RV) function was estimated by RV speckle strain (figure) and TAPSE (tricuspid plane systolic excursion) in this study.
Methods: In total, 49 consecutive patients admitted for acute decompensated HF were enrolled (Age73±14 years, 30male). Their ejection fractions (EF) were uniformly reduced (HFrEF, LVEF=32.1±4.4%, Na=138±4.5mEq/l, eGFR=42±23 ml/min/1.72cm2). They were administered TLV at 7.5-15 mg/day for one week. Non-response to TLV was defined as no evidence of a 1 kg decrease in body weight (BW) during the week following TLV treatment. Blood sampling and echocardiography, including strain imaging, were performed just prior to starting TLV. Vivid q and Echo PAC PC (GE, Norway) were used for echocardiographic analyses including strain. We analyzed LV function by global longitudinal strain (GLS) and left atrial (LA) function by 2D speckle strain from the 4ch view.
Results: Although 39 patients decreased their BW by more than 1kg (ΔBW= 5.4±0.7kg), 10 patients were non-responders (ΔBW=0.6±0.4kg). (Table)Logistic regression analysis showed that RV dysfunction (RV strain, TAPSE) and renal dysfunction (eGFR ml/min/1.73m2) were significant predictors for non-response to TLV. However, neither GLS nor E/e’ were significant predictors in this study. Accordingly, RV function was more important than LV function in patients with HFrEF in predicting the effectiveness of TLV.
Conclusions: From the result of our echocardiographical study, RV dysfunction can be an important predictor of the effectiveness of TLV in patients with HFrEF.
- © 2013 by American Heart Association, Inc.