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Comparative efficacy and safety of chronic torasemide and furosemide therapy in patients with compensated heart failure. Effect on markers of myocardial fibrosis

Ageev F. T., Zhubrina E. S., Gilyarevsky S. R., Mareev V. Yu., Khoseva E. N., Golshmid M. V., Deev A. D., Kotkina T. I., Lukina Yu. V., Malishevsky M. V., Masenko V. P., Rogozhkina Yu. A., Seredenina E. M., Sinitsina I. I., Suslikov A. V., Titov V. N.

Keywords: NT-proBNP, aldosterone, fibrosis markers, loop diuretic, CHF

DOI: 10.18087/rhfj.2013.2.1801

Background. The use of loop diuretics plays an important role in therapy for symptomatic CHF. Aim. Comparative evaluation of clinical efficacy of torasemide (Trigrim®, Polpharma, Poland) and furosemide (N. A. Semashko Moskhimfarmpreparaty) in patients with CHF and effect of these therapies on markers of myocardial fibrosis. Materials and methods. 108 patients with compensated II–III NYHA FC CHF receiving a standard therapy for HF were randomized to groups receiving torasemide (n=55; mean dose, 9.8±5.9 mg) or furosemide (n=53; mean dose, 28.7±14.7 mg). Clinical and hemodynamic status, quality of life, LV function, and serum levels of electrolytes, aldosterone, procollagen type I C-terminal propeptide (PICP), the marker of type I collagen synthesis, and С-terminal telopeptide of collagen type I (CITP), the marker collagen type I degradation. Results. Study results demonstrated safety and efficacy of the loop diuretics, torasemide and furosemide, for reducing the average FC and severity of clinical condition and increasing the quality of life in patients with moderately compensated CHF (р<0.05 for all comparisons). However only the torasemide therapy was associated with significantly increased 6min walk distance and LV contractility, improved Doppler parameters of LV filling pressure (Е / e′) and considerably decreased NT-proBNP and aldosterone (р<0.05 for all comparisons). At the same time, the furosemide therapy was associated with significant increases in the type I collagen synthesis marker, PICP and the PICP / CITP ratio (р<0.05). Conclusion. This study showed that both torasemide and furosemide are safe and effective for decreasing the FC and increasing the quality of life in patients with compensated CHF. However the clinical hemodynamic effect of torasemide is superior to that of furosemide, probably due to additional antialdosterone mechanisms of torasemide, which may influence the heart function including synthesis of collagen type I.
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Ageev F. T., Zhubrina E. S., Gilyarevsky S. R. et al. Comparative efficacy and safety of chronic torasemide and furosemide therapy in patients with compensated heart failure. Effect on markers of myocardial fibrosis. Russian Heart Failure Journal. 2013;14 (2):55-62

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