| Autor: |
Alexopoulos, George P., Anastasiou-Nana, Maria I., Rapti, Ageliki Ch., Margari, Zafiria J., Terrovitis, John V., Mitsibounas, Dimitrios, Makri, Stamatina, Nanas, John N. |
| Zdroj: |
Acta cardiologica; December 2003, Vol. 58 Issue: 6 p513-517, 5p |
| Abstrakt: |
Objectives— This study was performed to examine the safety of reducing the long-term doses of furosemide administered to patients with congestive heart failure (CHF) stabilized on a standard medical treatment.Methods and results— Twenty-nine patients with advanced CHF were treated with enalapril, digoxin, nitrates, and furosemide, as needed to alleviate their symptoms, and remained clinically stable for at least 3 months on those doses. Subsequently, the daily dose of furosemide was reduced to 1/3 of the previous dose, while the concomitant therapy was unchanged. All patients underwent a thorough clinical evaluation and right-heart catheterization before and 2 months after the furosemide dose reduction. After the treatment optimization the NYHA functional class decreased from 2.3±0.6 to 1.4±0.6 (p = 0.000), and the left ventricular ejection fraction increased from 22±10% to 32±13%, (p = 0.000). Clinical and haemodynamic evaluation before and after 2 months of treatment with lower furosemide doses showed that 24 of the 29 patients (83%) remained in a stable NYHA functional class and maintained a stable haemodynamic status. In the remaining 5 patients (17%), mean NYHA functional class increased from 1.8±0.4 to 2.4±0.6 (p = 0.07), accompanied by a significant increase of the right and left ventricular filling pressures from 4.2±2.7 to 9.0±3.0 mm Hg, p = 0.018 and from 8.6±3.0 to 19.8±3.6 mm Hg, p = 0.017, respectively. These 5 patients returned to a stable clinical status upon resumption of the prior doses of furosemide.Conclusions— Most patients with chronic CHF who were clinically stabilized on high doses of furosemide remained stable on a maintenance dose equal to one-third of the dose needed for their stabilization. Patients unable to tolerate the dose reduction regained their previous clinical status following the resumption of the prior diuretic doses. |
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