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Wang W, Gao F, He X, Gao Y, Shi L, Liu W, Zhuang X. Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection. BMC Cardiovasc Disord 2023; 23:95. [PMID: 36803437 PMCID: PMC9942290 DOI: 10.1186/s12872-023-03125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Despite the increasing application of tolvaptan in cardiac surgery, there is no information on the use of tolvaptan in Stanford patients with type A aortic dissection. This study aimed to evaluate the postoperative clinical effects of tolvaptan in patients with type A aortic dissection after tafter surgery. METHODS A retrospective analysis was performed on 45 patients treated for type A aortic dissection in our hospital from 2018 to 2020. These included 21 patients who were treated with tolvaptan (Group T) and 24 patients who received traditional diuretics (Group L). The hospital's electronic health records were used to obtain perioperative data. RESULTS Group T did not differ significantly from Group L in terms of the duration of mechanical ventilation, postoperative blood required, length of catecholamine use, or the amount of intravenous diuretic drugs administered (all P > 0.05). The development of postoperative atrial fibrillation was significantly less in the tolvaptan group (P = 0.023). The urine volumes and change in body weight loss were slightly higher in group T than in group L but the differences were non-significant (P > 0.05). Serum potassium, creatinine, and urea nitrogen levels did not differ between the groups in the week after surgery, At the same time, sodium was significantly higher in the Group T group on day 7 after transfer from the ICU (P = 0.001). In Group L, sodium levels were also elevated by day 7 (P = 0.001). On days 3 and 7, serum creatinine and urea nitrogen levels increased in both groups (both P < 0.05). CONCLUSIONS Both tolvaptan and traditional diuretics were found to be effective and safe for patients with acute Stanford type A aortic dissection. Moreover, tolvaptan may be associated with reducing the incidence of postoperative atrial fibrillation.
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Affiliation(s)
- Wenjun Wang
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Feng Gao
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Xuezhi He
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Yang Gao
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Lei Shi
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Wei Liu
- grid.452337.40000 0004 0644 5246Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Xijing Zhuang
- Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China.
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Lin YH, Tsai CH, Chiang CE, Kuo JY, Yin WH, Wen MS, Lo PH, Liu PY, Lin TH, Chen ZC, Shyu KG, Hung MJ, Hwang JJ, Tseng CD. The Efficacy and Safety of Short-Term Tolvaptan Usage in Patients with Acute Decompensated Heart Failure. ACTA CARDIOLOGICA SINICA 2022; 38:700-713. [PMID: 36440253 PMCID: PMC9692217 DOI: 10.6515/acs.202211_38(6).20220422a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/22/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients admitted with acute decompensated heart failure (ADHF) have a poor prognosis and poor quality of life due to dyspnea and edema. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective water diuretic. This study aimed to evaluate the efficacy and safety of a short course of tolvaptan to treat volume overload in patients with ADHF. METHODS We conducted a phase III, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a short course of tolvaptan (15 mg/day for 4 days) in hospitalized ADHF patients with volume overload despite the use of conventional diuretics. The primary end-point was the change in body weight after 4 days of treatment. The secondary end-points were the change in intake/output balance, change in serum sodium/potassium concentrations, physician/patient assessed signs and symptoms of heart failure after 4 days of treatment, and all-cause mortality in 1 month. RESULTS A total of 110 patients were screened, and 91 were randomized to receive 15 mg/day of tolvaptan for 4 days (n = 46) or matching placebo (n = 45). Compared to the placebo-treated patients, tolvaptan significantly reduced body weight (-1.36 ± 2.13 kg in the tolvaptan group vs. -0.59 ± 1.27 kg in the placebo group, p = 0.0394). The tolvaptan group also had a negative intake/urine volume balance compared to the placebo group (-509.3 ± 2788.2 ml vs. 975.5 ± 1903.1 ml, p = 0.0059). The safety profile of tolvaptan was acceptable. CONCLUSIONS Tolvaptan significantly reduced volume overload in hospitalized ADHF patients with volume overload despite the use of conventional diuretics.
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Affiliation(s)
- Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;
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Department of Internal Medicine, National Taiwan University Hospital JinShan Branch, New Taipei City
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital and Faculty of Medicine, National Yang Ming University, Taipei
| | - Ming-Shien Wen
- Division of Cardiology, Chang Gung Memorial Hospital-Linkou and Chang Gung University, College of Medicine, Taoyuan
| | - Ping-Han Lo
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University;
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Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital;
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Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Zhih-Cherng Chen
- Division of Cardiovascular Medicine, Chi Mei Medical Center, Tainan
| | - Kou-Gi Shyu
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Ming-Jui Hung
- Chang Gung Memorial Hospital-Keelung, Chang Gung University College of Medicine, Keelung
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;
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Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chuen-Den Tseng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;
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Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
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Sato N, Uno S, Kurita Y, Kim S. Efficacy and safety of intravenous OPC-61815 compared with oral tolvaptan in patients with congestive heart failure. ESC Heart Fail 2022; 9:3275-3286. [PMID: 35794067 DOI: 10.1002/ehf2.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/06/2022] [Accepted: 06/03/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS This multicentre, randomized, controlled, double-blind, parallel-group Phase III study was conducted to confirm the non-inferiority of OPC-61815 (tolvaptan sodium phosphate) intravenous injections to oral tolvaptan tablets in patients with congestive heart failure and volume overload despite receiving diuretics other than vasopressin antagonists. METHODS AND RESULTS Congestive heart failure patients with volume overload despite receiving diuretics other than vasopressin antagonists were randomly assigned (1:1) to receive OPC-61815 (16-mg injection; n = 149) or oral tolvaptan (15-mg tablet; n = 145) once daily for 5 days. Most patients were male; the mean age and weight were 74.7 years and 62.1 kg, respectively; other demographic and clinical characteristics were similar between groups. In this study, the primary endpoint was the change in body weight from baseline to the day after the last dose. Secondary endpoints included improvement from baseline in congestive findings and New York Heart Association classification. The change in body weight was -1.67 kg [95% confidence interval (CI): -1.93, -1.41] and -1.36 kg (95% CI: -1.62, -1.10) in the OPC-61815 group and tolvaptan group, respectively; the difference in the least squares mean between the groups was -0.31 kg (95% CI: -0.68, 0.06). Given the upper CI did not exceed the pre-specified limit of 0.48, this confirmed the non-inferiority of injectable OPC-61815 to oral tolvaptan. Daily urine volume and daily fluid intake increased, and daily fluid balance was negative throughout the treatment period; changes were similar for both groups. All evaluated congestive symptoms and New York Heart Association classifications showed improvement and safety findings were similar between the groups. The incidence of hyperkalaemia was higher in the OPC-61815 group, and the incidence of thirst and dry mouth was higher in the tolvaptan group. Most treatment-emergent adverse events were mild to moderate; one serious treatment-emergent adverse event of hyperkalaemia in the OPC-61815 group was considered treatment related. CONCLUSIONS OPC-61815 (16-mg injection) was confirmed as non-inferior to oral tolvaptan (15-mg tablet) in patients with congestive heart failure and inadequate response to diuretics; no new safety concerns were observed.
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Affiliation(s)
- Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Shingo Uno
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Yuka Kurita
- Medical Affairs Department, Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Seongryul Kim
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co. Ltd., Osaka, Japan
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Tamaki S, Yamada T, Morita T, Furukawa Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Ueda K, Kimura T, Sakamoto D, Tamura Y, Fujita T, Fukunami M. Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:933-937. [PMID: 32243100 PMCID: PMC7261536 DOI: 10.1002/ehf2.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Acute decompensated heart failure (ADHF) is generally treated by decongestion using diuretic therapy. However, the use of loop diuretics is associated with increased cardiac sympathetic nerve activity (CSNA). We aimed to evaluate the effect of adjunctive tolvaptan therapy on CSNA in ADHF patients with preserved left ventricular ejection fraction (LVEF). METHODS AND RESULTS We enrolled 51 consecutive ADHF patients with LVEF ≥45%. Patients were randomly assigned to receive either tolvaptan add-on (n = 25) or conventional diuretic therapy (n = 26). Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging was performed after stabilisation of heart failure symptoms, and the cardiac MIBG heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated. There were no significant differences in the body weight change and total urine volume during 2 days after randomisation or in the HMR on delayed image (HMR(d)) and WR between the tolvaptan and conventional groups. After stratification based on the median change in body weight, the patients with higher weight reduction had a significantly lower HMR(d) (P = 0.0128) and tended to have a higher WR (P = 0.0786) in the conventional group, whereas the cardiac MIBG imaging results were not influenced by body weight reduction in the tolvaptan group. CONCLUSIONS Adjunctive tolvaptan therapy may provide rapid decongestion without a harmful effect on CSNA in ADHF patients with preserved LVEF.
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Affiliation(s)
- Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Furukawa
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Makoto Abe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kyoko Yamamoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kiyomi Kayama
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Kazuya Tanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kunpei Ueda
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takanari Kimura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daisuke Sakamoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yuto Tamura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takeshi Fujita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
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