Effects of torasemide on cardiac sympathetic nerve activity and left ventricular remodeling in patients with congestive heart failure

Shu Kasama ^1*, Takuji Toyama ¹, Takashi Hatori ¹, Hiroyuki Sumino ¹, Hisao Kumakura ², Yoshiaki Takayama ², Shuichi Ichikawa ², Tadashi Suzuki ¹ and Masahiko Kurabayashi ¹

¹ Department of Cardiovascular Medicine, Gunma University School of Medicine, Maebashi, Japan, Japan
² Department of Internal Medicine, Cardiovascular Hospital of Central Japan, Gunma, Japan., Japan

^* To whom correspondence should be addressed. E-mail: s-kasama{at}bay.wind.ne.jp.

Accepted 24 March 2006

Abstract

Objective: The activation of the renin- angiotensin-aldosterone system prevents the uptake of norepinephrine in the myocardium. Torasemide is a loop diuretic, and this drug is known to have an anti- aldosteronergic effect. However, its effect on cardiac sympathetic nerve activity (CSNA) has not been determined in patients with congestive heart failure (CHF).

Methods: Forty patients with nonischemic CHF (left ventricular ejection fraction [LVEF] < 45%) were randomly assigned to torasemide (4 to 8 mg/day; n=20), or furosemide (20 to 40 mg/day; n=20). All patients were also receiving treatment with angiotensin-converting enzyme (ACE) inhibitor. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from 123I-meta- iodobenzylguanidine (MIBG) were measured before and 6 months after treatment. The LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LVEF were also determined by echocardiography.

Results: After treatment, in patients receiving torasemide, TDS decreased from 44(8) to 36(8) (p<0.001), H/M ratio increased from 1.61(0.19) to 1.77(0.24) (p<0.001), and WR decreased from 52(12)% to 41(14)% (p=0.001). In addition, LVEDV decreased from 173(22) ml to 147(30) ml (p<0.001) and the LVESV decreased from 117 (19) ml to 95(24) ml (p<0.001). Although the LVEF tended to increase, the change was not statistically significant (from 31(7)% to 34(7)%; p=NS). On the other hand, there were no significant changes in these parameters in patients receiving furosemide. Moreover, there were significant correlations between the percent change of TDS and that of LVEDV (r=0.473, p<0.05) and the LVESV (r=0.579, p<0.01) after torasemide treatment.

Conclusion: These findings indicate that torasemide treatment can ameliorate CSNA and left ventricular remodeling in patients with CHF.

Keywords: 123I-meta-iodobenzylguanidine, aldosterone, heart failure, loop diuretics

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