1
|
Ambrosino M, Sangoi M, Monzer N, Irving B, Fiorilli P, Khazan B, Goldberg S. Tricuspid Regurgitation: A Review of Current Interventional Management. J Am Heart Assoc 2024; 13:e032999. [PMID: 38471826 DOI: 10.1161/jaha.123.032999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
Tricuspid regurgitation is a common yet clinically complex problem, traditionally managed with diuretic therapy with no observable mortality benefit. Older studies on surgical intervention observed poor outcomes; however, this clinical reasoning predates current surgical approaches and novel transcatheter technology. The tricuspid apparatus is a complex structure that poses a technical challenge for surgeons and interventional cardiologists. Recent advances in surgical techniques and transcatheter therapy, particularly edge-to-edge repair devices, have demonstrated promising results for safety, reduction in tricuspid regurgitation, and improving quality of life. We review the clinical, imaging, and hemodynamic findings that characterize patients who should be considered for intervention, alongside the rapidly evolving approaches to interventional management.
Collapse
Affiliation(s)
- Maxwell Ambrosino
- Pennsylvania Hospital University of Pennsylvania Philadelphia PA USA
| | - Matthew Sangoi
- Pennsylvania Hospital University of Pennsylvania Philadelphia PA USA
| | - Nasser Monzer
- Pennsylvania Hospital University of Pennsylvania Philadelphia PA USA
| | - Brett Irving
- Pennsylvania Hospital University of Pennsylvania Philadelphia PA USA
| | - Paul Fiorilli
- Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA
| | - Benjamin Khazan
- Pennsylvania Hospital University of Pennsylvania Philadelphia PA USA
| | - Sheldon Goldberg
- Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA
| |
Collapse
|
2
|
Yan J, Wu A, Liu L, Xu L, Kuang H, Xu C, Guo L. Development of an immunochromatographic assay for the rapid screening of torasemide in health food. Food Chem 2024; 432:137166. [PMID: 37607444 DOI: 10.1016/j.foodchem.2023.137166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
Torasemide is a new loop diuretic agent added illegally to health foods for weight loss, which can result in serious health risks for consumers. A rapid and sensitive immunochromatographic assay for detection of torasemide (ICA) based on a new monoclonal antibody (mAb) was developed. The mAb IC50 for torasemide was 0.93 ng/mL, and the mAb did not cross-react with other analogues. In PBS, the cut-off value and limit of detection were 1 ng/mL and 0.11 ng/mL, respectively, with a linear range between 0.61 and 6.13 ng/mL. In slimming tablet and capsule samples, the cut-off value was 5 ng/g. Recoveries were 101.1% ± 1.7%-106.1% ± 1.3% in tablet samples and 101.2% ± 2.2%-109.1% ± 3.9% in capsule samples, with coefficients of variation 2.1%-3.1% and 1.8%-3.6%, respectively, consistent with existing LC-MS/MS methods. Therefore, the ICA is suitable for use in slimming tablet and capsule samples.
Collapse
Affiliation(s)
- Jieyu Yan
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Aihong Wu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Liqiang Liu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Liguang Xu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Hua Kuang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Chuanlai Xu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China.
| | - Lingling Guo
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Research Laboratory for Biointerface and Biodetection, School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China.
| |
Collapse
|
3
|
Sherazi AW, Zamir A, Rehman AU, Ashraf W, Imran I, Saeed H, Majeed A, Saleem Z, Aziz M, Alqahtani F, Rasool MF. A Systematic Critical Review of Clinical Pharmacokinetics of Torasemide. Ther Drug Monit 2024:00007691-990000000-00161. [PMID: 38176856 DOI: 10.1097/ftd.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Torasemide is a potassium-sparing loop diuretic used to treat fluid retention associated with congestive heart failure and kidney and hepatic diseases. This systematic review was conducted to combine all accessible data on the pharmacokinetics (PK) of torasemide in healthy and diseased populations, which may help clinicians avert adverse drug reactions and determine the correct dosage regimen. METHODS Four databases were systematically searched to screen for studies associated with the PK of torasemide, and 21 studies met the eligibility criteria. The review protocol was registered in the PROSPERO database (CRD42023390178). RESULTS A decrease in maximum plasma concentration (C max ) was observed for torasemide after administration of the prolonged-release formulation in comparison to that after administration of the immediate-release formulation, that is, 1.12 ± 0.17 versus 1.6 ± 0.2 mcg/mL. After administering an oral dose of torasemide, a 2-fold increase in the area under the concentration-time curve (AUC) was reported in patients with congestive heart failure compared with the healthy population. Moreover, the patients with renal failure (clearance < 30 mL/min) showed an increase in value of AUC 0-∞ that is, 42.9 versus 8.091 mcg.h -1 .mL -1 compared with healthy subjects. In addition, some studies have reported interactions with different drugs, in which irbesartan showed a slight increase in the AUC 0-∞ of torasemide, whereas losartan and empagliflozin did not. CONCLUSIONS The current review summarizes all available PK parameters of torasemide that may be beneficial for avoiding drug-drug interactions in subjects with renal and hepatic dysfunction and for predicting doses in patients with different diseases.
Collapse
Affiliation(s)
- Abdul Wasay Sherazi
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Ammara Zamir
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Abdul Majeed
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; and
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Majid Aziz
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; and
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| |
Collapse
|
4
|
Siddiqi AK, Javaid H, Ahmed M, Dhawadi S, Batool L, Zahid M, Muslim MO, Naeem K, Mahmood F, Hussain A. Clinical Outcomes With Furosemide Versus Torsemide in Patients With Heart Failure: An Updated Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101927. [PMID: 37453532 DOI: 10.1016/j.cpcardiol.2023.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Despite potential advantages of torsemide over furosemide, <10% of the patients with heart failure (HF) are on torsemide in clinical practice. Prior studies comparing furosemide to torsemide in patients with HF have shown conflicting findings, regarding hospitalizations and mortality. We aimed to pool all the studies conducted to date and provide the most updated and comprehensive evidence, regarding the effect of furosemide vs torsemide in reducing mortality and hospitalizations in patients with HF. We conducted a comprehensive literature search of the PubMed/Medline, Cochrane Library and Scopus from inception till June 2023, for randomized and nonrandomized studies comparing furosemide to torsemide in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations and all-cause hospitalizations was extracted, pooled, and analyzed. Forest plots were created based on the random effects model. A total of 17 studies (n = 11,996 patients) were included in our analysis with a median follow-up time of 8 months. Our pooled analysis demonstrated no difference in all-cause mortality between furosemide and torsemide groups in HF patients (OR = 0.98, 95% CI: 0.75-1.29, P = 0.89). However, torsemide was associated with a significantly lesser incidence of HF-related hospitalizations (OR = 0.73, 95% CI: 0.54-0.99, P = 0.04), and all-cause hospitalizations (OR = 0.84, 95% CI: 0.73-0.98, P = 0.03), as compared to furosemide. Torsemide significantly reduces HF-related and all-cause hospitalizations as compared to furosemide, with no difference in mortality. We recommend transitioning from furosemide to torsemide in HF patients who are not attaining symptomatic control.
Collapse
Affiliation(s)
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Siwar Dhawadi
- Department of Medicine, Faculty of Medicine Monastir, Mosastir, Tunisia
| | - Laiba Batool
- Department of Medicine, CMH Institute of Medical Sciences, Multan, Pakistan
| | - Maheen Zahid
- Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | | | - Khadija Naeem
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Fizza Mahmood
- Department of Medicine, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
| | - Abbas Hussain
- Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| |
Collapse
|
5
|
Lindner ML, Lohmeyer JL, Adam EH, Zacharowski K, Weber CF. [Mechanisms of action and clinical application of diuretics in intensive care medicine]. Anaesthesiologie 2023; 72:757-770. [PMID: 37768358 DOI: 10.1007/s00101-023-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/29/2023]
Abstract
The paired kidneys play a significant role in the human body due to the multitude of physiological tasks. Complex biochemical processes keep the sensitive electrolyte and water balance stable and thus ensure the organism's ability to adapt to exogenous and endogenous factors, which is essential for survival. The drug class of diuretics includes substances with very differing pharmacological characteristics. The functioning of the nephron is therefore indispensable for a deeper understanding of the pharmacodynamics, pharmacokinetics and side effect profile of diuretics. In the treatment of acute heart failure with pulmonary congestion, certain diuretics represent an important therapeutic option to counteract hypervolemia and thus an increase in preload. According to current data, diuretics have no proven benefits in the treatment or prevention of acute kidney injury but they can counteract hypervolemia and under certain conditions even reduce the use of renal replacement procedures.
Collapse
Affiliation(s)
- M-L Lindner
- Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Asklepios Kliniken Hamburg GmbH, Asklepios Klinik Wandsbek, Alphonsstraße 14, 22043, Hamburg, Deutschland.
| | - J L Lohmeyer
- Abteilung für Anästhesiologie, Intensiv‑, Notfall-, und Schmerzmedizin, Asklepios Kliniken Hamburg GmbH, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland
| | - E H Adam
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor Stern Kai 7, 60590, Frankfurt, Deutschland
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor Stern Kai 7, 60590, Frankfurt, Deutschland
| | - C F Weber
- Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Asklepios Kliniken Hamburg GmbH, Asklepios Klinik Wandsbek, Alphonsstraße 14, 22043, Hamburg, Deutschland
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor Stern Kai 7, 60590, Frankfurt, Deutschland
| |
Collapse
|
6
|
YU LY, LIU LY, TAN DH, TIAN HF, ZHENG P. Torasemide-induced IgA vasculitis in a patient with heart failure. J Geriatr Cardiol 2023; 20:548-550. [PMID: 37576483 PMCID: PMC10412542 DOI: 10.26599/1671-5411.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Affiliation(s)
- Lin-Yu YU
- Department of Pharmacy, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang-Yu LIU
- Office of Drug Clinical Trial Institution, Ganzhou People’s Hospital, Ganzhou, China
| | - Deng-Hang TAN
- Department of Pharmacy, Guihang Guiyang Hospital, Guiyang, China
| | - Hai-Fen TIAN
- Department of Pharmacy, Baise People's Hospital of Guangxi Zhuang Autonomous Region, Baise, China
| | - Ping ZHENG
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
7
|
Girerd N, Mewton N, Tartière JM, Guijarro D, Jourdain P, Damy T, Lamblin N, Bayes-Génis A, Pellicori P, Januzzi J, Rossignol P, Roubille F. Practical outpatient management of worsening chronic heart failure. Eur J Heart Fail 2022; 24:750-761. [PMID: 35417093 PMCID: PMC9325366 DOI: 10.1002/ejhf.2503] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 11/12/2022] Open
Abstract
Management of worsening heart failure (WHF) has traditionally been hospital‐based, but with the rising burden of heart failure (HF), the pressure on healthcare systems exerted by this disease necessitates a different strategy than long (and costly) hospital stays. A strategy for outpatient intravenous (IV) diuretic treatment of WHF has been developed in certain American centres in the past 10 years, whereas European centres have been mostly favouring ‘classic’ in‐hospital management of WHF. Embracing novel, outpatient approaches for treating WHF could substantially reduce the burden on healthcare systems while improving patient's satisfaction and quality of life. The present article is intended to provide essential knowledge and practical guidelines aimed at helping clinicians implement these new ambulatory approaches using day hospital and/or at‐home hospitalization. The topics addressed by our group of HF experts include the pathophysiological background of diuretic therapy, the most suitable profile of WHF that may be managed in an ambulatory setting, the pharmacological protocols that can be used, as well as a detailed description of healthcare structures that can be proposed to deliver these ambulatory care interventions. The practical aspects of day hospital and hospital‐at‐home IV diuretic administration are specifically emphasized. The algorithm provided along with the practical IV diuretic protocols should assist HF clinicians in implementing this new approach in their local clinical setting.
Collapse
Affiliation(s)
- Nicolas Girerd
- Université de Lorraine, Centre d'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel Hospices Civils de Lyon Heart Failure Department Clinical Investigation Center Inserm 1407 CarMeN Inserm 1060, University Claude Bernard Lyon 1 28 Avenue Doyen Lépine 69500, Bron
| | | | - Damien Guijarro
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
| | - Patrick Jourdain
- Covidom regional telemedicine platform, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiology Department, University Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris, Kremlin Bicêtre, France
| | - Thibaud Damy
- Réseau cardiogen, Department of Cardiology, centre français de référence de l'amylose cardiaque (CRAC), CHU d'Henri-Mondor, AP-HP, 94000, Créteil, France
| | - Nicolas Lamblin
- Department of Cardiology, Université de Lille, 59000, Lille, France
| | - Antoni Bayes-Génis
- CIBERCV; Servicio de Cardiología. Hospital Germans Trias i Pujol. Universitat Autònoma de Barcelona. Barcelona., Spain
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James Januzzi
- Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, MA, USA
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| |
Collapse
|
8
|
Abstract
INTRODUCTION Torsemide is a loop diuretic that inhibits the Na+/K+/2Cl- cotransporter type 2 in the thick ascending loop of Henle, leading to increased excretion of urinary sodium and chloride and associated diuresis. While furosemide remains the dominant diuretic utilized in current practice, increasing evidence supports potential advantages of torsemide in heart failure (HF) and/or renal disease. AREAS COVERED This narrative review covers the evidence for use of torsemide in HF and renal disease. Comparative effectiveness with regards to clinical outcomes is reviewed, as well as the ongoing multicenter trial, TRANSFORM-HF, comparing the effect of torsemide versus furosemide among patients with HF. EXPERT OPINION Compared with furosemide, torsemide has favorable pharmacodynamics/pharmacokinetics including higher bioavailability, longer duration of effect, minor renal excretion, decreased kaliuresis, and enhanced natriuresis/diuresis. These properties may be further supported by differential effects on RAAS regulation and fibrosis modulation as compared with other diuretics. The limited current body of evidence indicates that torsemide may be superior to furosemide with respect to improving HF functional status and reducing HF hospitalization, and there are mixed data regarding effect on reducing overall cardiovascular hospitalizations/mortality. Further, randomized data are necessary to definitively determine if torsemide can reduce risk of mortality and hospitalization among patients with HF.
Collapse
Affiliation(s)
- Anthony E. Peters
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Robert J. Mentz
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Tracy A. DeWald
- Division of Clinical Pharmacology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Stephen J. Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|