Russian Heart Failure Journal 2011year Comparative study of Torasemide vs. Furosemide effects on clinical status and diastolic function of the left ventricle in patients with compensated heart failure and high ventricular filling pressure


To access this material please log in or register

Register Authorize
2011/

Comparative study of Torasemide vs. Furosemide effects on clinical status and diastolic function of the left ventricle in patients with compensated heart failure and high ventricular filling pressure

Azizova A. G., Ovchinnikov A. G., Ageev F. T.
Federal State Budgetary Institution, “Russian Cardiology Research and Production Complex” of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: left ventricle filling pressure, diastolic dysfunction of left ventricle,  loop diuretic, heart failure

DOI: 10.18087/ rhfj.2011.6.1604

Relevance. Diuretics play the leading part in elimination of venostasis symptoms. However, until now there have been no large-scale studies carried out to estimate efficacy of long-term administration of diuretics in patients with compensated CHF, which does not allow to judge effects of these drugs on the disease prognosis. Purpose. The assessment of effects of the loop diuretics (Torasemide and Furosemide) on the clinical progression and diastolic function of LV in patients with compensated HF and high LV feeling pressure. Materials and methods. 63 patients with II–III class HF, high LV feeling pressure (EchoCG), yet without clinical signs of fluid retention, were randomized to Torasemide (n=33) and Furosemide (n=31) groups. Initial dose of Torasemide was 5 mg, Furosemide – 10 mg a day. In 2 weeks, and, if necessary, in 4 weeks, in the absence of due clinical haemodynamic effect (absence of transition to class I and / or to LV feeling type with the slowed down relaxation) doses of the diuretics were raised (Torasemide to 10 and 20 mg, Furosemide to 20 and 40 mg, respectively). The duration of the study was 6 months. Results. By the end of the study both groups demonstrated comparable significant lowering of average HF functional class, which was more expressed in Torasemide group (р<0.1) in comparison with the change of this parameter in the Furosemide group). Only administration of Torasemide was accompanied with significant increase of 6‑minute walk distance. By the end of dose-finding period, in both groups Doppler results of the indices closely connected with pressure of LV filling improved (significant decrease of E / A, Е / é and E / Vp ratios). However, further administration of Furosemide was accompanied by partial return of these parameters to the initial value, while Torasemide administration continued to have a positive effect on these indices (р <0.1 differences between the drugs of the effect on Е / A ratio and р<0.05 differences of the effect on Е / é and E / Vp ratios). Thus, in patients with compensated HF and high LV filling pressure both Torasemide and Furosemide improve the functional status and reduce LV filling pressure, and Torasemide has more expressed clinical haemodynamic effect, which is, probably, connected with the fact that it has additional mechanisms of influence on heart function.
  1. Faris R, Flather MD, Purcell H et al. Diuretics for heart failure. Cochrane Database Syst Rev. 2006 Jan 25; (1):CD003838.
  2. Dickstein K, Cohen-Solal A, Filippatos G et al; ESC Committee for Practice Guidelines (CPG) / ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008;10 (10):933–989.
  3. Cosin J, Diez J. Torasemide in chronic heart failure: Results of the TORIC study. Eur J Heart Fail. 2002;4 (4):507–513.
  4. Uchida T, Yamanaga K, Nishikawa M et al. Anti-aldosteronergic effect of torasemide. Eur J Pharmacol. 1991;205 (2):145–150.
  5. Uchida T, Yananaga K, Kido H et al. Diuretic and vasodilating actions of torasemide. Cardiology. 1994;84 (Suppl 2):14–17.
  6. Goodfriend TL, Ball DL, Oelkers W, Bahr V. Torasemide inhibits aldosterone secretion in vitro. Life Sci. 1998;63 (3):PL45–50.
  7. Yamato M, Sasaki T, Honda K et al. Effects of torasemide on left ventricular function and neurohumoral factors in patients with chronic heart failure. Circ J. 2003;67 (5):384–390.
  8. Lopez B, Querejrta R, Gonzalez A et al. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol. 2004;43 (11):2028–2035.
  9. Nagueh SF, Appleton CP, Gillebert TC et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22 (2):107–133.
  10. Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol. 1997;30 (1):8–18.
  11. Nagueh S, Middleton K, Kopelen H et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30 (6):1527–1533.
  12. Garcia M, Ares M, Asher C et al. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol. 1997;29 (2):448–454.
  13. Appleton C, Galloway J, Gonzalez M et al. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease: additional value of analyzing left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol. 1993;22 (7):1972–1982.
  14. Shin S, Lim H, Choi U et al. Impaired transport function of the left atrium in patients with lone paroxysmal atrial fibrillation. Echocardiography. 2011;28 (1):44–51
  15. Meta-Analysis Research Group in Echocardiography (MeRGE) AMI Collaborators. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation. 2008;117 (20):2591–2598.
  16. Свирида О. Н., Овчинников А. Г., Агеев Ф. Т. Влияние кандесартана и его комбинации со спиронолактоном на диастолическую функцию левого желудочка и содержание биохимических маркеров баланса коллагена у пациентов с хронической сердечной недостаточностью и сохранённой систолической функцией левого желудочка. Журнал Сердечная недостаточность 2010;11 (5):263–275.
  17. Verma S, Silke B, Hussain M et al. First-line treatment of left ventricular failure complicating acute myocardial infarction: a randomised evaluation of immediate effects of diuretic, venodilator, arteriodilator, and positive inotropic drugs on left ventricular function. J Cardiovasc Pharmacol. 1987;10 (1):38–46.
  18. Tanaka H, Watanabe K, Harima M et al. Effects of various diuretics on cardiac function in rats with heart failure. Yakugaku Zasshi. 2009;129 (7):871–879.
  19. Veeraveedu P, Watanabe K, Ma M et al. Comparative effects of torasemide and furosemide in rats with heart failure. Biochem Pharmacol. 2008;75 (3):649–659.
  20. Laurent GJ. Dynamic state of collagen: pathways of collagen degradation in vivo and their possible role in regulation of collagen mass. Am J Physiol. 1987;252 (1 Pt 1):C1–9.
  21. Opie L, Kaplan N. Diuretics. In: Opie L, Gersh B. (eds): Drugs for the heart (6th ed). Elsevier Saunders 2005; pp. 80–103.
Azizova A.G., Ovchinnikov A.G., Ageev F.T. Comparative study of Torasemide vs. Furosemide effects on clinical status and diastolic function of the left ventricle in patients with compensated heart failure and high ventricular filling pressure. Russian Heart Failure Journal2011;12(6):326-332.

To access this material please log in or register

Register Authorize
Ru En