Comparative Effects of Long-acting and Short-acting Loop Diuretics on Cardiac Sympathetic Nerve Activity in Patients with Chronic Heart Failure

Overview

Journal Open Heart

Publisher BMJ Publishing Group

Specialty Cardiology & Vascular Diseases

Date 2016 Feb 13

PMID 26870386

Citations 8

Authors

Yae Matsuo

Shu Kasama

Takuji Toyama

Ryuichi Funada

Noriaki Takama

Norimichi Koitabashi

Shuichi Ichikawa

Yasuyuki Suzuki

Naoya Matsumoto

Yuichi Sato

Masahiko Kurabayashi

Affiliations

Soon will be listed here.

Abstract

Objective: Short-acting loop diuretics are known to enhance cardiac sympathetic nerve activity (CSNA) in patients with chronic heart failure (CHF). The effects of two loop diuretics-long-acting azosemide and short-acting furosemide-on CSNA were evaluated using (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in patients with CHF.

Methods: The present study was a subanalysis of our previously published study, which had reported that serial (123)I-MIBG studies were the most useful prognostic indicator in patients with CHF. Patients with CHF (n=208, left ventricular ejection fraction <45%) but no history of cardiac events for at least 5 months prior to the study were identified according to their histories of acute decompensated heart failure requiring hospitalisation. Patients underwent (123)I-MIBG scintigraphy immediately before hospital discharge and at a 6-month follow-up. The delayed % denervation, delayed heart/mediastinum count (H/M) ratio and washout rate (WR) were determined using (123)I-MIBG scintigraphy. A total of 108 patients were selected, and propensity score matching was used to compare patients treated with either oral azosemide (n=54) or furosemide (n=54).

Results: After treatment, (123)I-MIBG scintigraphic parameters improved in both groups. However, the degree of change in % denervation was -13.8±10.5 in the azosemide group and -5.7±12.7 in the furosemide group (p<0.01), the change in H/M ratio was 0.20±0.16 in the azosemide group and 0.06±0.19 in the furosemide group (p<0.01), and the change in WR was -11.3±9.2% in the azosemide group and -3.0±12.7% in the furosemide group (p<0.01). Moreover, multivariate analysis showed an independent and significant positive relationship between furosemide and δ-WR from hospital discharge to 6 months after treatment in patients with CHF (p=0.001).

Conclusions: These findings indicate that azosemide suppresses CSNA compared with furosemide in patients with CHF.

Trial Registration Number: UMIN000000626 (UMIN-CTR Clinical Trial).

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