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Therapeutic Research
Abstract
Purpose:Diuretics are essential medicine to treat severe systemic congestion with chronic heart failure (HF). Although tolvaptan, selective V2 antagonist, has been available for refractory edema in congestive HF, there is patient who do not respond adequately. The aim of this study is to evaluate the factor of inadequate response for tolvaptan administration. Method:Eleven hospitalized patients with refractory congestive HF were examined for adding tolvaptan to conventional diuretic therapy. Systolic blood pressure( SBP), inferior vena cava(IVC) diameter and estimated right ventricle pressure (TRPG) as ultrasound cardio graphy parameter were obtained before tolvaptan administration. Urine volume change for tolvaptan administration was compared with these indexes. Results:Average age of patients was 75.7 years old, NYHA class was Ⅲ or Ⅳ. Classification of chronic kidney disease was stage Ⅰ(1[9%]), Ⅱ(1[9%]), Ⅲ(2[18%]), Ⅳ (5[45%]), Ⅴ (2[18%]), respectively. Mean BNP was 1259±1005 pg/mL. Start for administration of tolvaptan was 9.8 days on average from admission, and applied torvaptan for a period of at least two days, the average dose was 10.2±3.7mg/day. Change of urine volume (UV) show a positive correlation with SBP, IVC diameter had low inversely correlated with change of UV, whereas tricuspid regurgitation pressure gradient had no statistical association. Change of UV was positive correlation with SBP(r = 0.590,p = 0.013). IVC diameter was inversely correlated with change of UV(r = 0.664,p = 0.007), whereas TRPG was not statistical association(r = 0.329,p = 0.232). Conclusion:Low SBP reduce tolvaptan efficacy due to decreased renal blood flow. Though increased IVC diameter is not directly related to venous pressure, marked IVC dilatation, more than 30 mm in this study group, might be related to renal dysfunction which resulted from renal congestion as cardiorenal syndrome in chronic congestive HF.
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