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Clinical efficacy of tolvaptan in acute decompensated heart failure patients with severe aortic stenosis and atrial fibrillation: a sub-analysis from the LOHAS registry

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Abstract

Background

Severe aortic valve stenosis (AS) and atrial fibrillation (AF) are risk factors of hemodynamic instability in heart failure (HF) management due to low cardiac output, respectively. Therefore, the treatment of HF due to severe AS complicated with AF is anticipated to be difficult. Tolvaptan, a vasopressin V2 receptor inhibitor, is effective in controlling acute decompensated heart failure (ADHF) with hemodynamic stability. However, its clinical efficacy against ADHF caused by AS with AF remains to be determined.

Methods

Clinical information (from September 2014 to December 2017) of 59 patients diagnosed with ADHF due to severe AS (20 patients with AF; 39 patients with sinus rhythm [SR]) was obtained from the LOHAS registry. The registry collected data from seven hospitals and assessed the short-term effects of tolvaptan in patients hospitalized for ADHF with severe AS. We attempted to identify clinical differences from baseline up to 4 days, comparing patients with AF (AF group) versus those with SR (SR group).

Results

There were no significant differences between the groups in age (83.7 ± 4.5 vs. 85.8 ± 6.9 years, respectively; p = 0.11) and aortic valve area (0.60 [0.46–0.73] vs. 0.56 [0.37–0.70] cm2, respectively; p = 0.50). However, left atrial volume was larger (104 [85–126] vs. 87 [64–103] mL, respectively; p < 0.01), whereas stroke volume was lower (51.6 ± 14.8 vs. 59.0 ± 18.7 mL, respectively; p = 0.08) in the AF group versus the SR group. Body weight decreased daily from baseline up to day 4 in both groups (from 55.4 to 53.2 kg [p < 0.01] and from 53.5 to 51.0 kg [p < 0.01], respectively) without change in heart rate. Notably, the systolic blood pressure decreased slightly in the AF group after 2 days of treatment with tolvaptan.

Conclusions

Short-term treatment with tolvaptan improved HF in patients hospitalized for severe AS, regardless of the presence of AF or SR. After achieving sufficient diuresis, a slight decrease in blood pressure was observed in the AF group, suggesting an appropriate timeframe for safe and effective use of tolvaptan.

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Acknowledgements

This study was performed on behalf of SUNRISE Lab.

Funding

This study was supported by Otsuka Pharmaceutical Co., Ltd.

Author information

Authors and Affiliations

  1. Tokai University School of Medicine, Kanagawa, Japan

    Tsutomu Murakami, Norihito Nakamura, Makoto Natsumeda, Yohei Ohno, Gaku Nakazawa & Yuji Ikari

  2. Teikyo University School of Medicine, Tokyo, Japan

    Yusuke Watanabe, Akihisa Kataoka & Ken Kozuma

  3. Kindai University Faculty of Medicine, Osaka, Japan

    Gaku Nakazawa & Kazuki Mizutani

  4. St. Luke’s International Hospital, Tokyo, Japan

    Yosuke Nishihata

  5. Keio University School of Medicine, Tokyo, Japan

    Kentaro Hayashida

  6. Nagoya Heart Center, Aichi, Japan

    Masanori Yamamoto

  7. Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan

    Jun Tanaka

  8. Nishiarai Heart Center Hospital, Tokyo, Japan

    Kentaro Jujo

  9. St. Marianna University School of Medicine, Kanagawa, Japan

    Masaki Izumo

  10. Osaka City University School of Medicine, Osaka, Japan

    Kazuki Mizutani

Authors
  1. Tsutomu Murakami
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Correspondence to Yusuke Watanabe.

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Murakami, T., Watanabe, Y., Nakamura, N. et al. Clinical efficacy of tolvaptan in acute decompensated heart failure patients with severe aortic stenosis and atrial fibrillation: a sub-analysis from the LOHAS registry. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02397-3

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