Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow and normal-flow severe aortic stenosis
Conventional diuretic therapy for low-flow (LF) severe aortic stenosis (SAS) often has an inadequate effect or causes hemodynamic instability. Tolvaptan is used for acute heart failure in addition to conventional diuretics, and it does not cause intravascular dehydration. This study aimed to retrosp...
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| Veröffentlicht in: | Heart and vessels 2019-10, Vol.34 (10), p.1684-1691 |
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| creator | Mitsui, Miho Kataoka, Akihisa Nara, Yugo Nagura, Fukuko Kawashima, Hideyuki Hioki, Hirofumi Nakashima, Makoto Watanabe, Yusuke Yokoyama, Naoyuki Kozuma, Ken |
| description | Conventional diuretic therapy for low-flow (LF) severe aortic stenosis (SAS) often has an inadequate effect or causes hemodynamic instability. Tolvaptan is used for acute heart failure in addition to conventional diuretics, and it does not cause intravascular dehydration. This study aimed to retrospectively investigate the safety and efficacy of tolvaptan in the acute phase in 56 consecutive patients with SAS and compared LF-SAS with normal-flow (NF) SAS. The primary endpoints were adverse clinical events (death, worsening heart failure, worsening renal failure, fatal arrhythmia, cardiogenic or hypovolemic shock, and use of inotropic agents) and the volume of urine within 48 h of tolvaptan administration. Among 56 patients, 16 had LF-SAS (29%), and 40 had NF-SAS (71%). Severe adverse clinical events were not observed 48 h after tolvaptan administration. In both groups, the urine volume significantly increased after tolvaptan administration in comparison to 24 h before tolvaptan administration (both,
p
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| doi_str_mv | 10.1007/s00380-019-01411-3 |
| format | Article |
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p
< 0.01). There were no changes in the urine volume during the initial 24 and 48 h. In the LF-SAS group, tolvaptan resulted in a significant decrease in fluid balance during the initial 24 and 48 h compared to 24 h before tolvaptan administration (
p
< 0.05). Adding tolvaptan to conventional treatment is safe and effective without renal dysfunction and hypotension in patients with SAS, including those with LF.</description><identifier>ISSN: 0910-8327</identifier><identifier>EISSN: 1615-2573</identifier><identifier>DOI: 10.1007/s00380-019-01411-3</identifier><identifier>PMID: 30993439</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Aged ; Aged, 80 and over ; Antidiuretic Hormone Receptor Antagonists - therapeutic use ; Aortic stenosis ; Aortic Valve Stenosis - complications ; Arrhythmia ; Biomedical Engineering and Bioengineering ; Cardiac Surgery ; Cardiology ; Congestive heart failure ; Dehydration ; Diuretics ; Female ; Glomerular Filtration Rate ; Heart ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - etiology ; Hemodynamics ; Humans ; Hypotension ; Japan ; Low flow ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Patients ; Renal failure ; Renal function ; Retrospective Studies ; Safety ; Stability ; Stenosis ; Therapy ; Time Factors ; Tolvaptan - therapeutic use ; Treatment Outcome ; Urination - drug effects ; Urine ; Vascular Surgery</subject><ispartof>Heart and vessels, 2019-10, Vol.34 (10), p.1684-1691</ispartof><rights>Springer Japan KK, part of Springer Nature 2019</rights><rights>Springer Japan KK, part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-9337052c1d14a3d7febc1fb372f6570210f56222e5b6e9c18ddace7595cad8053</citedby><cites>FETCH-LOGICAL-c399t-9337052c1d14a3d7febc1fb372f6570210f56222e5b6e9c18ddace7595cad8053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00380-019-01411-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00380-019-01411-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30993439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mitsui, Miho</creatorcontrib><creatorcontrib>Kataoka, Akihisa</creatorcontrib><creatorcontrib>Nara, Yugo</creatorcontrib><creatorcontrib>Nagura, Fukuko</creatorcontrib><creatorcontrib>Kawashima, Hideyuki</creatorcontrib><creatorcontrib>Hioki, Hirofumi</creatorcontrib><creatorcontrib>Nakashima, Makoto</creatorcontrib><creatorcontrib>Watanabe, Yusuke</creatorcontrib><creatorcontrib>Yokoyama, Naoyuki</creatorcontrib><creatorcontrib>Kozuma, Ken</creatorcontrib><title>Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow and normal-flow severe aortic stenosis</title><title>Heart and vessels</title><addtitle>Heart Vessels</addtitle><addtitle>Heart Vessels</addtitle><description>Conventional diuretic therapy for low-flow (LF) severe aortic stenosis (SAS) often has an inadequate effect or causes hemodynamic instability. Tolvaptan is used for acute heart failure in addition to conventional diuretics, and it does not cause intravascular dehydration. This study aimed to retrospectively investigate the safety and efficacy of tolvaptan in the acute phase in 56 consecutive patients with SAS and compared LF-SAS with normal-flow (NF) SAS. The primary endpoints were adverse clinical events (death, worsening heart failure, worsening renal failure, fatal arrhythmia, cardiogenic or hypovolemic shock, and use of inotropic agents) and the volume of urine within 48 h of tolvaptan administration. Among 56 patients, 16 had LF-SAS (29%), and 40 had NF-SAS (71%). Severe adverse clinical events were not observed 48 h after tolvaptan administration. In both groups, the urine volume significantly increased after tolvaptan administration in comparison to 24 h before tolvaptan administration (both,
p
< 0.01). There were no changes in the urine volume during the initial 24 and 48 h. In the LF-SAS group, tolvaptan resulted in a significant decrease in fluid balance during the initial 24 and 48 h compared to 24 h before tolvaptan administration (
p
< 0.05). Adding tolvaptan to conventional treatment is safe and effective without renal dysfunction and hypotension in patients with SAS, including those with LF.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antidiuretic Hormone Receptor Antagonists - therapeutic use</subject><subject>Aortic stenosis</subject><subject>Aortic Valve Stenosis - complications</subject><subject>Arrhythmia</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Congestive heart failure</subject><subject>Dehydration</subject><subject>Diuretics</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - etiology</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Japan</subject><subject>Low flow</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Patients</subject><subject>Renal failure</subject><subject>Renal function</subject><subject>Retrospective Studies</subject><subject>Safety</subject><subject>Stability</subject><subject>Stenosis</subject><subject>Therapy</subject><subject>Time Factors</subject><subject>Tolvaptan - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Urination - drug effects</subject><subject>Urine</subject><subject>Vascular Surgery</subject><issn>0910-8327</issn><issn>1615-2573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFvFCEUx4mxsdvqF_BgSLx4GfseLDvD0Wxq26SJFz0Tlnm408zCCEybvfrJpZ2qiQcPPMLj9_6Q_Bh7i_ARAdqLDCA7aAB1XWvERr5gK9ygaoRq5Uu2Ao3QdFK0p-ws5zsAVBr1K3YqQWu5lnrFfm7HIQzOjjxbT-XIbeg5eV9b7sij5yWO93YqNnAfE7duLsSnvc3Ey56SnY58CHyyZaBQMn8Yyp6P8aHxtTxlhZgOdlzOme4pEbcxlcHxXCjEPOTX7MTbMdOb5_2cfft8-XV73dx-ubrZfrptnNS6NFrKFpRw2OPayr71tHPod7IVfqNaEAhebYQQpHYb0g67vreOWqWVs30HSp6zD0vulOKPmXIxhyE7GkcbKM7ZiBqhlULEir7_B72Lcwr1d5XqWpAI60dKLJRLMedE3kxpONh0NAjm0ZBZDJlqyDwZMrIOvXuOnncH6v-M_FZSAbkAuV6F75T-vv2f2F9cbZzt</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Mitsui, Miho</creator><creator>Kataoka, Akihisa</creator><creator>Nara, Yugo</creator><creator>Nagura, Fukuko</creator><creator>Kawashima, Hideyuki</creator><creator>Hioki, Hirofumi</creator><creator>Nakashima, Makoto</creator><creator>Watanabe, Yusuke</creator><creator>Yokoyama, Naoyuki</creator><creator>Kozuma, Ken</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow and normal-flow severe aortic stenosis</title><author>Mitsui, Miho ; Kataoka, Akihisa ; Nara, Yugo ; Nagura, Fukuko ; Kawashima, Hideyuki ; Hioki, Hirofumi ; Nakashima, Makoto ; Watanabe, Yusuke ; Yokoyama, Naoyuki ; Kozuma, Ken</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-9337052c1d14a3d7febc1fb372f6570210f56222e5b6e9c18ddace7595cad8053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antidiuretic Hormone Receptor Antagonists - therapeutic use</topic><topic>Aortic stenosis</topic><topic>Aortic Valve Stenosis - complications</topic><topic>Arrhythmia</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Congestive heart failure</topic><topic>Dehydration</topic><topic>Diuretics</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - etiology</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Japan</topic><topic>Low flow</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Patients</topic><topic>Renal failure</topic><topic>Renal function</topic><topic>Retrospective Studies</topic><topic>Safety</topic><topic>Stability</topic><topic>Stenosis</topic><topic>Therapy</topic><topic>Time Factors</topic><topic>Tolvaptan - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Urination - drug effects</topic><topic>Urine</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mitsui, Miho</creatorcontrib><creatorcontrib>Kataoka, Akihisa</creatorcontrib><creatorcontrib>Nara, Yugo</creatorcontrib><creatorcontrib>Nagura, Fukuko</creatorcontrib><creatorcontrib>Kawashima, Hideyuki</creatorcontrib><creatorcontrib>Hioki, Hirofumi</creatorcontrib><creatorcontrib>Nakashima, Makoto</creatorcontrib><creatorcontrib>Watanabe, Yusuke</creatorcontrib><creatorcontrib>Yokoyama, Naoyuki</creatorcontrib><creatorcontrib>Kozuma, Ken</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Heart and vessels</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mitsui, Miho</au><au>Kataoka, Akihisa</au><au>Nara, Yugo</au><au>Nagura, Fukuko</au><au>Kawashima, Hideyuki</au><au>Hioki, Hirofumi</au><au>Nakashima, Makoto</au><au>Watanabe, Yusuke</au><au>Yokoyama, Naoyuki</au><au>Kozuma, Ken</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow and normal-flow severe aortic stenosis</atitle><jtitle>Heart and vessels</jtitle><stitle>Heart Vessels</stitle><addtitle>Heart Vessels</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>34</volume><issue>10</issue><spage>1684</spage><epage>1691</epage><pages>1684-1691</pages><issn>0910-8327</issn><eissn>1615-2573</eissn><abstract>Conventional diuretic therapy for low-flow (LF) severe aortic stenosis (SAS) often has an inadequate effect or causes hemodynamic instability. Tolvaptan is used for acute heart failure in addition to conventional diuretics, and it does not cause intravascular dehydration. This study aimed to retrospectively investigate the safety and efficacy of tolvaptan in the acute phase in 56 consecutive patients with SAS and compared LF-SAS with normal-flow (NF) SAS. The primary endpoints were adverse clinical events (death, worsening heart failure, worsening renal failure, fatal arrhythmia, cardiogenic or hypovolemic shock, and use of inotropic agents) and the volume of urine within 48 h of tolvaptan administration. Among 56 patients, 16 had LF-SAS (29%), and 40 had NF-SAS (71%). Severe adverse clinical events were not observed 48 h after tolvaptan administration. In both groups, the urine volume significantly increased after tolvaptan administration in comparison to 24 h before tolvaptan administration (both,
p
< 0.01). There were no changes in the urine volume during the initial 24 and 48 h. In the LF-SAS group, tolvaptan resulted in a significant decrease in fluid balance during the initial 24 and 48 h compared to 24 h before tolvaptan administration (
p
< 0.05). Adding tolvaptan to conventional treatment is safe and effective without renal dysfunction and hypotension in patients with SAS, including those with LF.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>30993439</pmid><doi>10.1007/s00380-019-01411-3</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Antidiuretic Hormone Receptor Antagonists - therapeutic use Aortic stenosis Aortic Valve Stenosis - complications Arrhythmia Biomedical Engineering and Bioengineering Cardiac Surgery Cardiology Congestive heart failure Dehydration Diuretics Female Glomerular Filtration Rate Heart Heart failure Heart Failure - drug therapy Heart Failure - etiology Hemodynamics Humans Hypotension Japan Low flow Male Medicine Medicine & Public Health Original Article Patients Renal failure Renal function Retrospective Studies Safety Stability Stenosis Therapy Time Factors Tolvaptan - therapeutic use Treatment Outcome Urination - drug effects Urine Vascular Surgery |
| title | Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow and normal-flow severe aortic stenosis |
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