Effects of Torasemide on Left Ventricular Function and Neurohumoral Factors in Patients With Chronic Heart Failure

Abstract

The effect of torasemide and furosemide therapy was compared in 50 patients who had chronic heart failure and symptoms [NYHA class II-III] despite long-term therapy with both low-dose furosemide and angiotensin-converting enzyme inhibitors. In this randomized 6-month, open-label trial, baseline and follow-up echocardiograms and neurohumoral assays were obtained in 25 group F patients (continued same dose of oral furosemide at 20-40 mg/day) and in 25 group T patients (received torasemide at 4-8 mg/day in place of furosemide). At 6 months, parameters were unchanged in group F whereas the group T patients had a lower left ventricular end-diastolic diameter (p<0.005) and left ventricular mass index (p<0.005) with improved Doppler filling parameters, decreased plasma B-type natriuretic concentration (p<0.001) and increased plasma concentrations of active renin (p<0.005) and aldosterone (p<0.001). The magnitude of these changes appeared dose dependent and it is suggested these favorable effects of switching from furosemide to torasemide may be related to aldosterone receptor blockade.

Torsemide Versus Furosemide After Continuous Renal Replacement Therapy Due to Acute Renal Failure in Cardiac Surgery Patients

“…[10 -14,24] The accurate potassium substitution performed in this study could have influenced aldosterone levels, as aldosterone secretion is dependent on potassium levels. [14] Renin concentrations were not significantly different in both groups. Activation of the RAAS by loop diuretics was found to differ in animal studies and in human studies.…”

“…[15] In animal experiments and one study done with CHF patients, an increase of aldosterone was found after loop diuretic therapy. [10,11,13,14] In in vitro, animal, and human studies in CHF patients, torsemide inhibited aldosterone binding to the receptor, causing an anti-aldosteronic effect with reduced kaliuresis. [10 -14,24] The accurate potassium substitution performed in this study could have influenced aldosterone levels, as aldosterone secretion is dependent on potassium levels.…”

“…Activation of the RAAS by loop diuretics was found to differ in animal studies and in human studies. [10,11,14,15] In the first time interval to last time interval comparison, sodium increased significantly in the furosemide group. Torsemide was given in equipotent doses to furosemide, and we expected similar natriuresis in both groups, as described in some studies.…”

Influence of diuretic therapy on the features of heart rhythm variability changes in chronic heart failure patients

“…Эти свойства определяют его повышенную эффективность у пациентов с ХСН, которая продемонстрирована в ряде контролируемых клинических исследо-ваний [4][5][6][7][8][9][10][11][12][13]. Эффективность торасемида обусловлена не только диуретическим эф-фектом, но и антиальдостероновыми меха-низмами.…”

Inhibition of aldosterone synthase (CYP11B2) by torasemide prevents atrial fibrosis and atrial fibrillation in mice

“…An important mediator of left ventricular and atrial fibrosis is the activation of mineralocorticoid receptors (MR) by aldosterone [10][11][12][13][14][15]. Interestingly, experimental and human studies have reported that torasemide, but not furosemide, may exert anti-aldosterone effects [16] [17,18]. However, the underlying mechanisms and the consequences of these observations are only partially understood, especially in the context of atrial fibrillation.…”