Djw. Van Kraaij et al., Furosemide withdrawal in elderly heart failure patients with preserved left ventricular systolic function, AM J CARD, 85(12), 2000, pp. 1461-1466
Citations number
20
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
To explore the possibilities of furosemide withdrawal in elderly heart fail
ure (HF) patients with intact left ventricular (LV) systolic function and a
ssess its effects on functional status and orthostatic blood pressure homeo
stasis, we performed a placebo-controlled pilot trial of furosemide withdra
wal with 3 months of follow-up in 32 HF patients (aged 75.1 +/- 0.7 years [
mean +/- SEM]) with a LV ejection fraction of 60 +/- 2% and without overt c
ongestion. Investigations included repeated clinical assessment, spirometry
, standardized 6-minute walking test, and chest x-rays, Measurements of blo
od pressure response on active standing and Doppler echocardiography were p
erformed before and 3 months after furosemide withdrawal. Recurrent congest
ive HF occurred in 2 of 21 patients (10%) who discontinued furosemide use,
and in 1 of 11 patients (9%) who continued furosemide (p = NS), Three patie
nts restarted furosemide for ankle edema and 1 for blood pressure levels >1
80/100 mm Hg. After 3 months, there were no differences regarding HF sympto
m scores, blood pressure, heart rate, spirometric results, 6-minute walking
distance, or quality of life scores between patients who discontinued use
and patients who continued the therapy. In patients successfully withdrawn,
Doppler E/A ratio increased from 0.68 +/- 0.05 to 0.79 +/- 0.06 after with
drawal (p < 0.01), and maximum blood pressure decrease on active standing c
hanged from -8 +/- 5 mm Hg to +5 +/- 3 mm Hg systolic (p < 0.05). Thus, in
this pilot investigation of furosemide withdrawal in elderly HF patients wi
thout overt congestion and with a normal LV systolic function, withdrawal w
as successful in almost all patients and was associated with improvement of
LV diastolic filling and blood pressure homeostasis on active standing. (C
) 2000 by Excerpta Medica, Inc.