Vasopressin Antagonists for the Treatment of Acute Decompensated Heart Failure: When, for Whom, for How Long, and on What Standard Therapy?

摘要

Acute decompensated heart failure (ADHF) is emerging as a major public health problem and has been associated with high short-term mortality and rehospitalization rates.1'2 Most patients with ADHF present with signs and symptoms of systemic and pulmonary congestion at admission and diuretics remain the most common treatment modality.3 Although diuretics initially reduce congestion and volume overload, they induce neurohormonal activation, electrolyte disturbances, and renal dysfunction. There has not been a randomized outcome trial of diuretics and it is unlikely that there will be (at least with a placebo control group), but there is a strong association of the need for high-dose diuretic with poor outcome.3 Moreover, 30% to 50% of patients are resistant to the effects of diuretics, having an abnormal fluid balance with minimal or no weight loss and persistent symptoms.