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Predictability of tricuspid annular plane systolic excursion for the effectiveness of tolvaptan in patients with heart failure

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Abstract

Background

There is no echocardiographic predictor of the effectiveness of tolvaptan in patients with heart failure (HF). The aim of this study was to investigate the echocardiographic predictor of responders to tolvaptan in patients with HF.

Methods

This observational study consisted of 62 consecutive in-hospital patients with HF who received tolvaptan with volume overload despite standard therapies. The echocardiography data were obtained within 1 week before the administration of tolvaptan. Tolvaptan responders were defined as those having a body weight decrease from baseline >1 kg on the morning of day 8.

Results

The mean age of the 62 patients was 75.1 ± 13.9 years, and 45 patients (72.6%) were considered to be responders. Tricuspid annular plane systolic excursion (TAPSE) was significantly higher (17.1 ± 3.8 vs. 13.0 ± 3.9 mm; p = 0.0004) and the tricuspid valve regurgitation pressure gradient (33.3 ± 14.6 vs. 44.9 ± 12.2 mmHg; p = 0.007) and estimated right atrium pressure (7.8 ± 4.2 vs. 10.3 ± 4.5 mmHg; p = 0.043) were significantly lower in the Responder group than in the Non-responder group. In a multivariate logistic regression analysis, TAPSE was found to be an independent predictor of response (odds ratio 1.28; 95% confidence interval 1.03–1.60). According to the receiver operating characteristics analysis, the area under the curve of TAPSE was the largest among the parameters measured by echocardiography. The cut-off value for TAPSE to predict responders was determined to be 17.0 mm (sensitivity = 56.8%, specificity = 94.1%).

Conclusions

TAPSE is a simple predictor of the effectiveness of tolvaptan in patients with HF.

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Abbreviations

TAPSE:

Tricuspid annular plane systolic excursion

RAAS:

Renin–angiotensin–aldosterone system

V2R:

Vasopressin V2 receptor

HF:

Heart failure

LV:

Left ventricle

LA:

Left atrium

RV:

Right atrium

SV:

Stroke volume

PW:

Pulsed wave

EF:

Ejection fraction

TR-PG:

Pressure gradient of tricuspid valve regurgitation

PCWP:

Pulmonary capillary wedge pressure

CI:

Cardiac index

PVR:

Pulmonary vascular resistance

GFR:

Glomerular filtration rate

RBF:

Renal blood flow

WRF:

Worsening renal function

AQP-2:

Aquaporin-2

ROC:

Receiver operating characteristic curve

VTI:

Velocity–time integral

AUC:

Area under the curve

NYHA:

New York Heart Association

CVP:

Central venous pressure

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Acknowledgements

The authors thank Drs. Heidi N. Bonneau, RN, MS, CCA and Sachiko Fukuta for their review of this manuscript, and Ms. Arisawa, Mr. Kanda, and Ms. Kiba for their excellent technical assistance.

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Authors and Affiliations

  1. Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Japan

    Toru Niwa, Katsuhisa Waseda, Tomofumi Mizuno, Yusuke Nakano, Kentaro Mukai, Hirokazu Wakabayashi, Atsushi Watanabe, Hirohiko Ando, Hiroaki Takashima & Tetsuya Amano

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  1. Toru Niwa
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  2. Katsuhisa Waseda
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  3. Tomofumi Mizuno
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  4. Yusuke Nakano
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  5. Kentaro Mukai
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  6. Hirokazu Wakabayashi
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  7. Atsushi Watanabe
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  8. Hirohiko Ando
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  10. Tetsuya Amano
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Corresponding author

Correspondence to Tomofumi Mizuno.

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This study was not supported by any grants, contracts, or other forms of financial support. There are no relationships with industry to report.

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Niwa, T., Waseda, K., Mizuno, T. et al. Predictability of tricuspid annular plane systolic excursion for the effectiveness of tolvaptan in patients with heart failure. J Echocardiogr 15, 118–126 (2017). https://doi.org/10.1007/s12574-017-0330-z

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  • DOI: https://doi.org/10.1007/s12574-017-0330-z

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