Loop Diuretic Therapy in Severe Aortic Stenosis: Marker of Organ Congestion, Unfavorable Hemodynamics, and Increased Post-Valve Replacement Mortality

2025/12/01 by Maeder, Micha, Breuss, Alexander, Appert, Sharon +7
Medicine · #Cardiac Valve Diseases and Treatments #Cardiovascular Function and Risk Factors #Heart Failure Treatment and Management

paper · doi:10.5167/uzh-281138

Abstract

Background: Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR). Methods: Consecutive patients with severe AS with [n = 157; median (interquartile range) daily torasemide dose: 10 (5-15) mg] or without (n = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied. Conclusions: LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.

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