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<p>For severe aortic stenosis (AS) patients awaiting valve replacement, managing acute decompensated heart failure (ADHF) is crucial due to poor prognosis. The LOHAS registry evaluated the effect of tolvaptan in patients (mean age: 85&#xa0;years) with severe AS and ADHF, demonstrating stable hemodynamics and sufficient diuresis. We investigated predictors of rapid successful decongestion. In the LOHAS study, eligible patients received tolvaptan (7.5&#xa0;mg) on day 1 plus standard ADHF treatments. Patients were divided based on decongestion achievement on day 4. Of 59 enrolled, 35 (59%) achieved decongestion (decongestion group), and 24 (41%) remained congested (congestion group). Changes in body weight, renal function, and hemodynamics were comparable between groups over the first 4&#xa0;days. However, the maximum inferior vena cava (IVC) diameter at admission was significantly larger in the decongestion group than the congestion group (12.6 ± 6.3 vs. 7.6 ± 4.8&#xa0;mm, <i>p</i> = 0.007). ROC analysis revealed a cut-off of 11&#xa0;mm for maximum IVC diameter to predict decongestion on day 4 (AUC: 0.73, 95% CI 0.58–0.88). In-hospital mortality was lower in the decongestion group (0% vs. 13%, <i>p</i> = 0.06). In conclusion, in this high-risk severe AS and ADHF population, adding tolvaptan to standard therapy may rapidly improve decompensation if patients have a sufficiently expanded IVC at admission. Maximum IVC diameter could predict successful decongestion with tolvaptan.</p> Graphical abstract <p></p>

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Predictors of the diuretic response in acute decompensated heart failure patients with severe aortic stenosis: sub-analysis of the LOHAS registry

  • 期刊论文

  • 发表日期：

    2025年2月11日

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  • Takuma Takada,
  • Kentaro Jujo,
  • Takuro Abe,
  • Kensuke Shimazaki,
  • Yugo Nara,
  • Hirofumi Hioki,
  • Hideyuki Kawashima,
  • Akihisa Kataoka,
  • Makoto Nakashima,
  • Masanori Yamamoto,
  • Kazuki Mizutani,
  • Masaki Izumo,
  • Gaku Nakazawa,
  • Ken Kozuma,
  • Katsumi Saito,
  • Yusuke Watanabe

摘要

For severe aortic stenosis (AS) patients awaiting valve replacement, managing acute decompensated heart failure (ADHF) is crucial due to poor prognosis. The LOHAS registry evaluated the effect of tolvaptan in patients (mean age: 85 years) with severe AS and ADHF, demonstrating stable hemodynamics and sufficient diuresis. We investigated predictors of rapid successful decongestion. In the LOHAS study, eligible patients received tolvaptan (7.5 mg) on day 1 plus standard ADHF treatments. Patients were divided based on decongestion achievement on day 4. Of 59 enrolled, 35 (59%) achieved decongestion (decongestion group), and 24 (41%) remained congested (congestion group). Changes in body weight, renal function, and hemodynamics were comparable between groups over the first 4 days. However, the maximum inferior vena cava (IVC) diameter at admission was significantly larger in the decongestion group than the congestion group (12.6 ± 6.3 vs. 7.6 ± 4.8 mm, p = 0.007). ROC analysis revealed a cut-off of 11 mm for maximum IVC diameter to predict decongestion on day 4 (AUC: 0.73, 95% CI 0.58–0.88). In-hospital mortality was lower in the decongestion group (0% vs. 13%, p = 0.06). In conclusion, in this high-risk severe AS and ADHF population, adding tolvaptan to standard therapy may rapidly improve decompensation if patients have a sufficiently expanded IVC at admission. Maximum IVC diameter could predict successful decongestion with tolvaptan.

Graphical abstract