Background
Methods
Study patients
Clinical characteristics
Echocardiography
Definitions
Statistical analysis
Results
Clinical characteristics
Tolvaptan group | Conventional group | p value | |
---|---|---|---|
Number | 26 | 180 | |
Age (years) | 75 ± 11 | 74 ± 12 | 0.88 |
Sex (male,%) | 15 (58) | 96 (53) | 0.68 |
BMI (kg/m2) | 23.8 ± 4.4 | 23.6 ± 4.4 | 0.77 |
Previous HF hospitalization | 2.1 ± 1.7 | 0.5 ± 0.9 | <0.001 |
Etiology of heart failure | |||
Ischemic heart disease | 8 (31) | 68 (38) | 0.87 |
Dilated cardiomyopathy | 5 (19) | 30 (17) | |
Valvular heart disease | 5 (19) | 26 (14) | |
Others | 8 (31) | 56 (31) | |
Comorbid disease | |||
Hypertension | 20 (77) | 136 (76) | 0.88 |
Diabetes mellitus | 14 (54) | 81 (45) | 0.40 |
Dyslipidemia | 10 (38) | 73 (41) | 0.84 |
Atrial fibrillation | 19 (73) | 69 (38) | <0.001 |
Vital sign on admission | |||
Heart rate (bpm) | 79 ± 18 | 96 ± 27 | <0.001 |
SBP (mmHg) | 123 ± 27 | 150 ± 38 | <0.001 |
DBP (mmHg) | 71 ± 17 | 84 ± 22 | <0.01 |
Blood chemistry on admission | |||
Hemoglobin (g/dl) | 10.3 ± 2.1 | 11.5 ± 2.3 | <0.05 |
BUN (mg/dl) | 48 ± 27 | 28 ± 17 | <0.001 |
Scr (mg/dl) | 2.0 ± 1.0 | 1.5 ± 1.4 | <0.001 |
eGFR (ml/min/1.73 m2) | 30.7 ± 17.6 | 50.1 ± 27.3 | <0.001 |
eGFR <30 ml/min/1.73 m2 (%) | 15 (58) | 47 (26) | <0.005 |
Na (mEq/l) | 137 ± 6 | 139 ± 4 | 0.22 |
K (mEq/l) | 4.3 ± 1.0 | 4.2 ± 0.7 | 0.38 |
BNP (pg/ml) | 746 (241–1527) | 845 (465–1693) | 0.23 |
Medication on admission | |||
β-blockers | 18 (69) | 59 (33) | <0.001 |
RAS inhibitors | 20 (77) | 98 (54) | <0.05 |
Loop diuretics | 26 (100) | 92 (51) | <0.001 |
Thiazide diuretics | 8 (26) | 16 (9) | <0.005 |
Aldosterone antagonists | 14 (54) | 32 (18) | <0.05 |
Device therapy | 7 (27) | 28 (16) | 0.15 |
Echocardiography
Tolvaptan group | Conventional group | p value | |
---|---|---|---|
Number | 26 | 180 | |
2 dimensional echocardiography | |||
LVEF (%) | 45.8 ± 17.7 | 45.3 ± 17.0 | 0.84 |
LVDd (mm) | 53.8 ± 10.1 | 55.4 ± 9.8 | 0.35 |
LVDs (mm) | 41.4 ± 11.9 | 42.4 ± 12.0 | 0.67 |
LV end-diastolic volume index | 93.5 ± 39.2 | 102.4 ± 38.1 | 0.21 |
SWT (mm) | 9.8 ± 2.5 | 10.6 ± 2.9 | 0.15 |
PWT (mm) | 10.0 ± 2.0 | 10.4 ± 2.1 | 0.34 |
LA diameter (mm) | 53.4 ± 9.9 | 47.1 ± 8.5 | <0.001 |
LA volume index (ml/m2) | 96.0 ± 85.0 | 45.8 ± 25.9 | <0.0001 |
Maximum IVC diameter (mm) | 20.7 ± 6.9 | 18.1 ± 4.2 | <0.01 |
IVC collapsibility index | 0.35 ± 0.16 | 0.46 ± 0.15 | <0.001 |
Doppler echocardiography | |||
Diastolic dysfunction grade | |||
Mild | 0 | 19 | 0.06 |
Moderate | 1 | 27 | |
Severe | 6 | 38 | |
E/A | 2.1 ± 0.4 | 1.4 ± 0.8 | <0.005 |
DT (ms) | 173 ± 43 | 178 ± 55 | 0.23 |
E/e’ | 25.2 ± 19.5 | 22.4 ± 11.5 | 0.83 |
Valvular regurgitation | |||
AR severity grade | 0.7 ± 1.1 | 0.7 ± 1.0 | 0.88 |
AR jet vena contracta (mm) | 1.5 ± 2.4 | 1.5 ± 2.5 | 0.88 |
MR severity grade | 1.7 ± 0.8 | 1.6 ± 1.0 | 0.47 |
MR jet vena contracta (mm) | 4.5 ± 2.6 | 4.1 ± 2.8 | 0.57 |
TR severity grade | 1.1 ± 0.8 | 0.8 ± 0.6 | <0.05 |
TR jet vena contracta (mm) | 5.8 ± 5.1 | 3.6 ± 3.2 | <0.005 |
TR pressure gradient (mmHg) | 40.7 ± 13.0 | 42.3 ± 16.2 | 0.63 |
Prediction of responsiveness to tolvaptan
Responder | Non-responder | p value | |
---|---|---|---|
Number | 13 | 13 | |
Initial dose (mg) | 8.9 ± 4.5 | 7.5 ± 2.7 | 0.56 |
Age (years) | 74.0 ± 12.0 | 76.0 ± 10.0 | 0.76 |
Sex (male, %) | 9 (69) | 6 (46) | 0.23 |
BMI (kg/m2) | 23.5 ± 3.8 | 24.1 ± 5.1 | 0.64 |
Previous HF hospitalization | 2.5 | 1.7 | 0.35 |
Etiology of heart failure | |||
Ischemic heart disease | 3 (23) | 5 (38) | 0.70 |
Dilated cardiomyopathy | 2 (15) | 3 (23) | |
Valvular heart disease | 3 (23) | 2 (15) | |
Others | 5 (38) | 3 (23) | |
Comorbid disease | |||
Hypertension | 9 (69) | 11 (85) | 0.35 |
Diabetes mellitus | 6 (46) | 8 (62) | 0.43 |
Dyslipidemia | 3 (23) | 7 (54) | 0.10 |
Atrial fibrillation | 10 (69) | 9 (77) | 0.69 |
Vital sign on admission | |||
Heart rate (bpm) | 77 ± 11 | 80 ± 24 | 0.74 |
SBP (mmHg) | 117 ± 23 | 129 ± 29 | 0.28 |
DBP (mmHg) | 71 ± 15 | 72 ± 19 | 0.76 |
Blood chemistry on admission | |||
Hemoglobin (g/dl) | 10.6 ± 2.5 | 10.0 ± 1.7 | 0.72 |
BUN (mg/dl) | 42.0 ± 26.0 | 54.0 ± 29.0 | 0.23 |
Scr (mg/dl) | 1.9 ± 1.0 | 2.1 ± 1.0 | 0.59 |
eGFR (ml/min/1.73 m2) | 32.8 ± 17.3 | 28.6 ± 18.3 | 0.54 |
Na (mEq/l) | 136.0 ± 6.0 | 138.0 ± 5.0 | 0.34 |
K (mEq/l) | 4.3 ± 1.2 | 4.3 ± 0.6 | 0.37 |
BNP (pg/ml) | 475 (151–1106) | 917 (484–1766) | 0.07 |
Medication on admission | |||
β-blockers | 8 (62) | 10 (77) | 0.42 |
RAS inhibitors | 10 (77) | 10 (77) | 1.00 |
Loop diuretics | 13 (100) | 13 (100) | 1.00 |
Thiazide diuretics | 6 (46) | 2 (15) | 0.10 |
Aldosterone antagonists | 8 (62) | 6 (46) | 0.46 |
Device therapy | 3 (23) | 4 (31) | 0.69 |
Responder | Non-responder | p value | |
---|---|---|---|
Administration of β blockers | |||
Number | 8 | 10 | |
Heart rate (bpm) | 77 ± 11 | 80 ± 18 | 0.72 |
SBP (mmHg) | 108 ± 24 | 128 ± 30 | 0.14 |
DBP (mmHg) | 62 ± 11 | 72 ± 22 | 0.26 |
No β blockers | |||
Number | 5 | 3 | |
Heart rate (bpm) | 77 ± 12 | 82 ± 45 | 0.81 |
SBP (mmHg) | 132 ± 11 | 130 ± 33 | 0.91 |
DBP (mmHg) | 84 ± 12 | 69 ± 8 | 0.09 |
Administration of RAS inhibitors | |||
Number | 10 | 10 | |
Heart rate (bpm) | 78 ± 12 | 84 ± 27 | 0.58 |
SBP (mmHg) | 118 ± 24 | 136 ± 29 | 0.17 |
DBP (mmHg) | 69 ± 17 | 77 ± 19 | 0.32 |
No RAS inhibitors | |||
Number | 3 | 3 | |
Heart rate (bpm) | 74 ± 2 | 70 ± 5 | 0.29 |
SBP (mmHg) | 113 ± 23 | 105 ± 17 | 0.66 |
DBP (mmHg) | 77 ± 9 | 54 ± 5 | <0.05 |
Responder | Non-responder | p value | |
---|---|---|---|
Number | 13 | 13 | |
2 dimensional echocardiography | |||
LVEF (%) | 42.5 ± 19.0 | 49.1 ± 16.3 | 0.37 |
LVDd (mm) | 52.4 ± 10.4 | 55.2 ± 9.9 | 0.40 |
LVDs (mm) | 41.3 ± 12.3 | 41.5 ± 12.0 | 0.94 |
LVEDVi | 86.5 ± 40.2 | 100.6 ± 38.6 | 0.26 |
SWT (mm) | 9.3 ± 2.8 | 10.2 ± 2.1 | 0.28 |
PWT (mm) | 10.0 ± 2.5 | 10.1 ± 1.5 | 0.75 |
LAD (mm) | 53.4 ± 10.7 | 53.3 ± 9.5 | 0.98 |
LA volume index (ml/m2) | 111.9 ± 115.9 | 84.4 ± 57.1 | 0.50 |
Maximum IVC diameter (mm) | 21.8 ± 9.1 | 19.6 ± 4.1 | 0.43 |
IVC collapsibility index | 0.34 ± 0.15 | 0.4 ± 0.2 | 0.80 |
Doppler echocardiography | |||
Valvular regurgitation | |||
AR severity grade | 0.5 ± 1.1 | 0.8 ± 1.1 | 0.59 |
AR jet vena contracta (mm) | 1.1 ± 2.1 | 1.8 ± 2.6 | 0.40 |
MR severity grade | 1.7 ± 0.8 | 1.8 ± 0.9 | 0.82 |
MR jet vena contracta (mm) | 4.0 ± 2.2 | 4.8 ± 2.9 | 0.48 |
TR severity grade | 1.2 ± 0.8 | 1.1 ± 0.8 | 0.80 |
TR jet vena contracta (mm) | 6.6 ± 6.6 | 5.1 ± 3.5 | 0.48 |
TR pressure gradient (mmHg) | 38.6 ± 15.0 | 42.7 ± 11.0 | 0.44 |