Long-Term Effects and Prognosis in Acute Heart Failure Treated with Tolvaptan: The AVCMA Trial

Abstract

Background. Diuresis is a major therapy for the reduction of congestive symptoms in acute decompensated heart failure (ADHF) patients. We previously reported the efficacy and safety of tolvaptan compared to carperitide in hospitalized patients with ADHF. There were some reports of cardio- and renal-protective effects in carperitide; therefore, the purpose of this study was to compare the long-term effects of tolvaptan and carperitide on cardiorenal function and prognosis. Methods and Results. One hundred and five ADHF patients treated with either tolvaptan or carperitide were followed after hospital discharge. Levels of plasma B-type natriuretic peptide, serum sodium, potassium, creatinine, and estimated glomerular filtration rate were measured before administration of tolvaptan or carperitide at baseline, the time of discharge, and one year after discharge. These data between tolvaptan and carperitide groups were not different one year after discharge. Kaplan-Meier survival curves demonstrated that the event-free rate regarding all events, cardiac events, all cause deaths, and rehospitalization due to worsening heart failure was not significantly different between tolvaptan and carperitide groups. Conclusions. We demonstrated that tolvaptan had similar effects on cardiac and renal function and led to a similar prognosis in the long term, compared to carperitide.

Response to tolvaptan and its effect on prognosis in cirrhotic patients with ascites

“…Regarding prognosis, tolvaptan reduced the rate of in‐hospital mortality, and evidenced longer mortality similar to diuretics in heart failure, although no study has assessed these parameters in cirrhosis patients. In our study, patients who responded to tolvaptan showed prolonged survival compared to those who did not.…”

Safety and efficacy of long‐term tolvaptan therapy for decompensated liver cirrhosis

“…[15][16][17][18][19] Patients with heart failure treated with tolvaptan exhibited comparable results as those treated with carperitide regarding the event-free rates of cardiac events, deaths and re-hospitalization. 19 Regarding safety, tolvaptan reduced blood pressure less than did carperitide, and did not affect renal and cardiac function adversely after 1 year of treatment. 19 In contrast, no long-term safety and efficacy has been reported in patients with liver cirrhosis; therefore, the current study is the first report of the long-term safety and efficacy of tolvaptan in patients with cirrhosis.…”

Molecular mechanisms and clinical features of heart failure

“…Cumulative eventfree rates from all events ( Figure 9A), cardiac events ( Figure 9B), all cause deaths ( Figure 9C), and rehospitalizations due to worsening heart failure ( Figure 9D) were not significantly different between the tolvaptan and carperitide groups (all events : 72.5% vs. 72.2%, P = 0.8647 ; cardiac events : 74.5% vs. 79.6%, P = 0.4561 ; all cause deaths : 94.1% vs. 87.0%, P = 0.3011 ; rehospitalization due to worsening heart failure : 78.4% vs. 85.1%, P = 0.3362). These results suggest that tolvaptan had similar effects in terms of prognosis after discharge compared to carperitide 20) .…”

“…However, the daily urine volumes at Days 2, 3, and 4 were all significantly higher in the tolvaptan group than in the carperitide group in HFrEF patients (P < 0.05 for all) as shown in Figure 8B 19) . Moreover, we compared the longterm effects of tolvaptan on cardiorenal function and prognosis with those of carperitide based on the AVCMA study 20) . All patients were followedup for almost one year after discharge (mean 296 days, 14 -400 days).…”