Abstract
BackgroundIn dogs with congestive heart failure (CHF), the efficacy of torasemide, a loop diuretic, has been demonstrated. However, unlike in dogs and humans little has been described about the use of torasemide in the cat with spontaneous CHF. The objectives of this retrospective study were therefore to describe the therapeutic use of oral torasemide in cats with spontaneous CHF, document its potential adverse effects while reporting the clinical course of this feline population following torasemide administration in addition to standard medical therapy.ResultsMedical records of 21 client-owned cats with CHF (median age = 10.6 years [interquartile range (IQR) = 6.5–11.2]) receiving torasemide were reviewed. Data collected included torasemide dosages, other concurrent medications, physical examination features, echocardiographic data, and potential adverse effects during follow-up. A survival analysis was performed to estimate the time from diagnosis to cardiac death. Dyspnea related to CHF was identified in all cats (pleural effusion [8/21], pulmonary edema [5/21] or both [8/21]), associated with ascites in 4/21 cats. The CHF cause was determined by echocardiography in all cats: hypertrophic (n = 10), restrictive (n = 6), arrhythmogenic right ventricular (n = 3), dilated (n = 1) cardiomyopathies, and aortic valve abnormality (n = 1). At initiation, median torasemide dosage was 0.21 mg/kg [IQR = 0.17–0.23] q24h. Clinical signs declined in most cats (20/21) during the first 2 weeks with no remarkable adverse events. Median survival time after torasemide prescription was 182 days [IQR = 46–330]. A contemporary control group including 54 cats with CHF, receiving furosemide as sole loop diuretic treatment was compared with the study group. Median (IQR) survival time of cats in the control group was not significatively different (p = 0.962) from that of the torasemide group, i.e., 148 days (9–364), although the torasemide group included significantly more cats with recurrent episodes of CHF (52%) that the control group (19%).ConclusionsThis case series demonstrates that torasemide can be used in cats with spontaneous CHF. This therapeutic interest needs to be confirmed by prospective clinical trials.
Highlights
In dogs with congestive heart failure (CHF), the efficacy of torasemide, a loop diuretic, has been demonstrated
According to the American College of Veterinary Internal Medicine (ACVIM) consensus guidelines for the diagnosis and treatment of canine myxomatous mitral valve disease (MMVD), loop diuretics are recommended for both chronic and acute treatment of MMVD dogs in ACVIM stages C and D [1]
A recent trial on 366 MMVD dogs with past or current CHF demonstrated that torasemide administered orally once a day in addition to standard CHF therapy is non inferior to furosemide given twice a day and is associated with a two-fold reduction in the risk of reaching the composite cardiac endpoint composed of spontaneous cardiac death, euthanasia due to HF, and CHF worsening [9]
Summary
In dogs with congestive heart failure (CHF), the efficacy of torasemide, a loop diuretic, has been demonstrated. In human patients and small animals with congestive heart failure (CHF), diuretics are used as the first-line treatment of clinical signs related to fluid retention (e.g., ascites, dyspnea) regardless of the underlying cause [1, 2]. Loop diuretics, such as furosemide and torasemide, act on the Na+:K+:2Cl− cotransporter of the thick ascending loop of Henle, permitting the reduction of intravascular fluid volume with secondary decrease in preload venous and capillary pressures and relief of CHF signs [1,2,3,4]. A recent trial on 366 MMVD dogs with past or current CHF demonstrated that torasemide administered orally once a day in addition to standard CHF therapy is non inferior to furosemide given twice a day and is associated with a two-fold reduction in the risk of reaching the composite cardiac endpoint composed of spontaneous cardiac death, euthanasia due to HF, and CHF worsening [9]
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