Abstract
BackgroundNo study has investigated the admission echocardiographic characteristics of acute heart failure (AHF) patients who are resistant to conventional diuretics and require tolvaptan.MethodsWe retrospectively analyzed the echocardiographic characteristics of AHF patients who were resistant to conventional diuretics and took tolvaptan (tolvaptan group: 26 patients), and compared them to those who were sensitive to conventional diuretics (conventional group: 180 patients).ResultsThe tolvaptan group had a higher left atrial volume index (96.0 ± 85.0 mL/m2 vs. 45.8 ± 25.9 mL/m2, p < 0.0001), maximum inferior vena cava diameter (20.7 ± 6.9 mm vs. 18.1 ± 4.2 mm, p < 0.01), and higher tricuspid regurgitation grade (1.1 ± 0.8 vs. 0.8 ± 0.6, p < 0.05) than the conventional group. However, the left ventricular ejection fraction and end diastolic diameter were similar between the groups. Responders of tolvaptan had no significant echocardiographic differences compared to the non-responders.ConclusionsThe admission echocardiographic characteristics of AHF patients requiring tolvaptan included a larger left atrium, inferior vena cava, and more severe tricuspid regurgitation. Echocardiography may provide useful information for the early and appropriate initiation of tolvaptan.
Highlights
No study has investigated the admission echocardiographic characteristics of acute heart failure (AHF) patients who are resistant to conventional diuretics and require tolvaptan
Cardiac volume overload can be ameliorated by the appropriate restriction of sodium and water intake and conventional diuretics such as loop diuretics in many patients with AHF; it is difficult to be ameliorated in some patients, because conventional diuretics are less effective or cannot be administered in sufficient doses due to worsening renal function and electrolyte imbalances [3]
In Japan, tolvaptan is indicated for the treatment of volume overload in AHF patients who are resistant to conventional diuretics, and it should not be administered in all AHF patients because of the Nakada et al Cardiovascular Ultrasound (2015) 13:27 heavy economic burden to patients and society
Summary
No study has investigated the admission echocardiographic characteristics of acute heart failure (AHF) patients who are resistant to conventional diuretics and require tolvaptan. The regulation of cardiac volume and pressure overload is one of the most important therapeutic strategies for acute heart failure (AHF) [1, 2]. The decision to initiate tolvaptan is difficult immediately after admission. In Japan, tolvaptan is indicated for the treatment of volume overload in AHF patients who are resistant to conventional diuretics, and it should not be administered in all AHF patients because of the Nakada et al Cardiovascular Ultrasound (2015) 13:27 heavy economic burden to patients and society. Tolvaptan is difficult to administer to only patients who are accurately identified as being resistant to conventional diuretics immediately after admission. The early prediction of responsiveness to tolvaptan is difficult
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