TAKADA Takuma    Department   Graduate School of Medical Science, Graduate School of Medical Science    Position
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Predictors of the diuretic response in acute decompensated heart failure patients with severe aortic stenosis: sub-analysis of the LOHAS registry.
Journal	Formal name：Cardiovascular intervention and therapeutics Abbreviation：Cardiovasc Interv Ther ISSN code：18684297/18684297
Domestic / Foregin	Foregin
Volume, Issue, Page	40(3),pp.619-628
Author and coauthor	TAKADA Takuma†, JUJO Kentaro*, ABE Takuro, SHIMAZAKI Kensuke, NARA Yugo, HIOKI Hirofumi, KAWASHIMA Hideyuki, KATAOKA Akihisa, NAKASHIMA Makoto, YAMAMOTO Masanori, MIZUTANI Kazuki, IZUMO Masaki, NAGAZAWA Gaku, KOZUMA Ken, SAITO Katsumi, WATANABE Yusuke
Authorship	Lead author
Publication date	2025/02
Summary	For severe aortic stenosis (AS) patients awaiting valve replacement, managing acute decompensated heart failure (ADHF) is crucial due to poor prognosis. The LOHAS registry evaluated the effect of tolvaptan in patients (mean age: 85 years) with severe AS and ADHF, demonstrating stable hemodynamics and sufficient diuresis. We investigated predictors of rapid successful decongestion. In the LOHAS study, eligible patients received tolvaptan (7.5 mg) on day 1 plus standard ADHF treatments. Patients were divided based on decongestion achievement on day 4. Of 59 enrolled, 35 (59%) achieved decongestion (decongestion group), and 24 (41%) remained congested (congestion group). Changes in body weight, renal function, and hemodynamics were comparable between groups over the first 4 days. However, the maximum inferior vena cava (IVC) diameter at admission was significantly larger in the decongestion group than the congestion group (12.6 ± 6.3 vs. 7.6 ± 4.8 mm, p = 0.007). ROC analysis revealed a cut-off of 11 mm for maximum IVC diameter to predict decongestion on day 4 (AUC: 0.73, 95% CI 0.58-0.88). In-hospital mortality was lower in the decongestion group (0% vs. 13%, p = 0.06). In conclusion, in this high-risk severe AS and ADHF population, adding tolvaptan to standard therapy may rapidly improve decompensation if patients have a sufficiently expanded IVC at admission. Maximum IVC diameter could predict successful decongestion with tolvaptan.
DOI	10.1007/s12928-025-01100-1
PMID	39934604