RT Journal Article
SR Electronic
T1 Comparative effects of long-acting and short-acting loop diuretics on cardiac sympathetic nerve activity in patients with chronic heart failure
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000276
DO 10.1136/openhrt-2015-000276
VO 3
IS 1
A1 Yae Matsuo
A1 Shu Kasama
A1 Takuji Toyama
A1 Ryuichi Funada
A1 Noriaki Takama
A1 Norimichi Koitabashi
A1 Shuichi Ichikawa
A1 Yasuyuki Suzuki
A1 Naoya Matsumoto
A1 Yuichi Sato
A1 Masahiko Kurabayashi
YR 2016
UL http://openheart.bmj.com/content/3/1/e000276.abstract
AB 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 123I-metaiodobenzylguanidine (MIBG) scintigraphy in patients with CHF.Methods The present study was a subanalysis of our previously published study, which had reported that serial 123I-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 123I-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 123I-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, 123I-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).