{"id":"1706f057d648","type":"article","url":"https://hartvaat.nl/2020/06/01/tolvaptan-en-sympathische-activiteit-bij-acuut-hfpef/","title":"Tolvaptan en sympathische activiteit bij acuut HFpEF","title_en":"Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","hfref","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12690","source_url":"https://doi.org/10.1002/ehf2.12690","authors":["Shunsuke Tamaki","Takahisa Yamada","Takashi Morita","Yoshio Furukawa","Masato Kawasaki","Atsushi Kikuchi","Tsutomu Kawai","Masahiro Seo","Makoto Abe","Jun Nakamura","Kyoko Yamamoto","Kiyomi Kayama","Masatsugu Kawahira","Kazuya Tanabe","Kunpei Ueda","Takanari Kimura","Daisuke Sakamoto","Yuto Tamura","Takeshi Fujita","Masatake Fukunami"],"significance":4,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This study evaluated the effect of adjunctive tolvaptan therapy on cardiac sympathetic nerve activity in patients with acute decompensated HFpEF. The vasopressin receptor antagonist may attenuate the sympathoexcitatory effects of loop diuretics.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T18:38:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van adjuvant tolvaptan op sympathische activiteit bij acuut hartfalen met behouden ejectiefractie.","abstract_original":"AIMS: Acute decompensated heart failure (ADHF) is generally treated by decongestion using diuretic therapy. However, the use of loop diuretics is associated with increased cardiac sympathetic nerve activity (CSNA). We aimed to evaluate the effect of adjunctive tolvaptan therapy on CSNA in ADHF patients with preserved left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We enrolled 51 consecutive ADHF patients with LVEF ≥45%. Patients were randomly assigned to receive either tolvaptan add-on (n = 25) or conventional diuretic therapy (n = 26). Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging was performed after stabilisation of heart failure symptoms, and the cardiac MIBG heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated. There were no significant differences in the body weight change and total urine volume during 2 days after randomisation or in the HMR on delayed image (HMR(d)) and WR between the tolvaptan and conventional groups. After stratification based on the median change in body weight, the patients with higher weight reduction had a significantly lower HMR(d) (P = 0.0128) and tended to have a higher WR (P = 0.0786) in the conventional group, whereas the cardiac MIBG imaging results were not influenced by body weight reduction in the tolvaptan group. CONCLUSIONS: Adjunctive tolvaptan therapy may provide rapid decongestion without a harmful effect on CSNA in ADHF patients with preserved LVEF."}