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Right ventricular contractility affects the clinical efficacy of add-on tolvaptan following hospitalization for heart failure in patients with significant tricuspid regurgitation

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Abstract

Tricuspid regurgitation (TR) is a common condition that is independently associated with high mortality rates in patients with heart failure (HF). Several studies have demonstrated the clinical efficacy of add-on tolvaptan in patients hospitalized for HF. However, the effects of add-on tolvaptan in patients with significant TR are less well understood. Among the patients with moderate-to-severe TR assessed by transthoracic echocardiography during hospitalization for congestive HF, 39 patients who could complete the clinical course after starting add-on tolvaptan were included in the study. Rehospitalization due to HF and cardiac death were defined as adverse cardiac events in this study. We investigated the presence or absence of cardiac events within 2 years following the introduction of tolvaptan and evaluated echocardiographic functional parameters associated with cardiac events. The average patient age was 75 ± 14 years, and 23 patients (59%) experienced adverse cardiac events within 2 years after add-on tolvaptan administration. Serum creatinine (mg/dL) and brain natriuretic peptide (pg/mL) concentrations at discharge were significantly higher in patients with cardiac events than in those without cardiac events {1.48 [1.02–1.58] vs. 1.07 [0.79–1.41], p = 0.03; 526 [414–1044] vs. 185 [104–476], p = 0.01, respectively}. The presence or absence of past hospitalization for HF was also significantly higher in the event-positive group compared to event-free group (78 vs. 44%, p = 0.04). Comparison of echocardiographic parameters revealed that patients with cardiac events had a significantly lower left ventricular ejection fraction (40 ± 16 vs. 49 ± 15%, p = 0.049) and lower right ventricular fractional area change (RVFAC) (35 ± 12 vs. 45 ± 10%, p = 0.008) than those without cardiac events. Multiple logistic regression analysis revealed that RVFAC and past hospitalization for HF were independently associated with cardiac events following the introduction of tolvaptan (odds ratio, 0.934 and 4.992; p = 0.048 and 0.04, respectively). Right ventricular contractility as well as past history of admission for HF, left ventricular ejection fraction, renal function, and brain natriuretic peptide level at discharge may reflect the clinical outcomes after HF hospitalization in patients with significant TR who were treated with tolvaptan.

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Abbreviations

TR:

Tricuspid regurgitation

HF:

Heart failure

TTE:

Transthoracic echocardiography

RV:

Right ventricular

RVFAC:

Right ventricular fractional area change

LVEF:

Left ventricular ejection fraction

BNP:

Brain natriuretic peptide

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Acknowledgements

The authors are grateful for the support of the entire staff of the Ultrasound Examination Center, Showa University Hospital. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan

    Rumi Hachiya, Yasuhide Mochizuki, Saaya Ichikawa, Haruka Miyazaki, Saori Chino, Eiji Toyosaki, Masashi Ota, Hiroto Fukuoka & Toshiro Shinke

  2. Ultrasound Examination Center, Showa University Hospital, Tokyo, Japan

    Mina Shibakai, Yui Omomo, Yui Kuroki & Yukiko Endo

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  1. Rumi Hachiya
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  2. Yasuhide Mochizuki
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Correspondence to Yasuhide Mochizuki.

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Shinke and Mochizuki reported personal fees from Otsuka Pharmaceutical Co., Ltd. outside the submitted work. The other authors have no conflicts to disclose.

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Hachiya, R., Mochizuki, Y., Shibakai, M. et al. Right ventricular contractility affects the clinical efficacy of add-on tolvaptan following hospitalization for heart failure in patients with significant tricuspid regurgitation. Heart Vessels 37, 755–764 (2022). https://doi.org/10.1007/s00380-021-01973-1

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