Successful Treatment of Congestive Heart Failure Due to Severe Aortic Valve Stenosis with Low Dose Tolvaptan in Old Patients

Abstract

BackgroundSymptomatic patients with severe aortic stenosis (AS) are usually are operative candidates because medical therapy has little to offer. Tolvaptan (TLV) treatment resulted in favorable but modest changes in filling pressures associated with a significant increase in urine output. Therefore, TLV is a potential candidate to improve decompensated heart failure due to severe AS without hemodynamic instability.MethodsWe retrospectively investigated 5 patients over 80 years of age who admitted due to decompensated congestive heart failure with severe AS and treated with tolvaptan from April 2014 to March 2015.ResultsFour females and a male were examined. Mean age was 90.6±6.6 years. Compared to total urine volume of the day before treatment, those of the first day were increased (928±478 vs. 1203±517 ml, P=0.03). Urine osmolality tended to be increased in the first day of treatment (408±137 vs. 261±155 mOsm, P=0.06). NYHA classification was significantly improved 1 week after treatment (3.8±0.4 vs. 3.0±0.0, P=0.02). BNP levels were decreased 1 week after TLV treatment and at discharge (1264±796 vs. 635±470 pg/mL, P=0.03, vs. 538±343 pg/mL, P=0.03, respectively). Severe adverse events, including death, cardiogenic shock did not occur during TLV treatment.ConclusionsTLV treatment safely improved decompensated heart failure due to AS in old patients. Further prospective studies are warranted to confirm these results. BackgroundSymptomatic patients with severe aortic stenosis (AS) are usually are operative candidates because medical therapy has little to offer. Tolvaptan (TLV) treatment resulted in favorable but modest changes in filling pressures associated with a significant increase in urine output. Therefore, TLV is a potential candidate to improve decompensated heart failure due to severe AS without hemodynamic instability. Symptomatic patients with severe aortic stenosis (AS) are usually are operative candidates because medical therapy has little to offer. Tolvaptan (TLV) treatment resulted in favorable but modest changes in filling pressures associated with a significant increase in urine output. Therefore, TLV is a potential candidate to improve decompensated heart failure due to severe AS without hemodynamic instability. MethodsWe retrospectively investigated 5 patients over 80 years of age who admitted due to decompensated congestive heart failure with severe AS and treated with tolvaptan from April 2014 to March 2015. We retrospectively investigated 5 patients over 80 years of age who admitted due to decompensated congestive heart failure with severe AS and treated with tolvaptan from April 2014 to March 2015. ResultsFour females and a male were examined. Mean age was 90.6±6.6 years. Compared to total urine volume of the day before treatment, those of the first day were increased (928±478 vs. 1203±517 ml, P=0.03). Urine osmolality tended to be increased in the first day of treatment (408±137 vs. 261±155 mOsm, P=0.06). NYHA classification was significantly improved 1 week after treatment (3.8±0.4 vs. 3.0±0.0, P=0.02). BNP levels were decreased 1 week after TLV treatment and at discharge (1264±796 vs. 635±470 pg/mL, P=0.03, vs. 538±343 pg/mL, P=0.03, respectively). Severe adverse events, including death, cardiogenic shock did not occur during TLV treatment. Four females and a male were examined. Mean age was 90.6±6.6 years. Compared to total urine volume of the day before treatment, those of the first day were increased (928±478 vs. 1203±517 ml, P=0.03). Urine osmolality tended to be increased in the first day of treatment (408±137 vs. 261±155 mOsm, P=0.06). NYHA classification was significantly improved 1 week after treatment (3.8±0.4 vs. 3.0±0.0, P=0.02). BNP levels were decreased 1 week after TLV treatment and at discharge (1264±796 vs. 635±470 pg/mL, P=0.03, vs. 538±343 pg/mL, P=0.03, respectively). Severe adverse events, including death, cardiogenic shock did not occur during TLV treatment. ConclusionsTLV treatment safely improved decompensated heart failure due to AS in old patients. Further prospective studies are warranted to confirm these results. TLV treatment safely improved decompensated heart failure due to AS in old patients. Further prospective studies are warranted to confirm these results.