Therapeutic Evaluation For Tolvaptan To Treat Acute Myocardial Infarction Accompanied By Heart Failure

Objectives To investigate effective and safety for tolvaptan to treat acute anterior myocardial infarction accompanied by heart failure for short period.Methods The research group collected cases with acute anterior myocardial infarction accompanied by heart failure and among them 109 cases were in accordance with the inclusive criteria. They were randomly divided into treatment group( n=55) and control group( n=54). The control group was treated with hydrochlorothiazide( 25 mg one time,once a day) on the basis of the conventional therapy that includes drug therapy and percutaneous coronary intervention( PCI) for the acute anterior myocardial infarction patients. While the treatment group was treated by the oral Tolvaptan( 7.5mg every morning with the treatment cycle as 7 days) on the basis of conventional therapy. When the patients that confirm with the criteria were involved in the experiment, the base line features before the administration as well as the relevant research data after the administration of the patients were collected and recorded, mainly including: 1) to record the patients’ heart rate(HR), systolic pressure( SBP) as well as the diastolic pressure( DBP) data every day; 2) to collect the blood sample before medication, in the first day and seven day of mediation for testing the serum sodium(Na+), potassium(K+)concentration and serum urea nitrogen bun(BUN), serum creatinine( Scr) and estimate glomerular filtration rate( e GFR) as well as other kidney function indexes; 3) to assess the condition of dyspnea, orthopnea, lung rale as well as other congestive symptoms of cardiac failure; 4) to record the intake and output volume of the patients during the therapy every day in detail; 5) to collect the ultrasonic cardiogram parameter and plasma NT-Pro BNP data of the selected patients; 6) to record the major adverse cardiac events( MACE) as well as the adverse drug reactions during the therapy and the follow-up 1 month;8evaluating the adverse drug reactions in the two groups, the number of patients with thirst,dry, frequent micturition symptoms in treatment group is more than the number in contrast group, however, for other adverse drug reactions and major adverse cardiac events( MACE) within 1month there was no statistic difference in the two groups.Results In this clinical research, there totally were 109 patient cases that were in accordance with the inclusive criteria. The statistic analysis result showed that: 1comparing the baseline information of treatment group and control group, there was no significant statistical difference(P>0.05); 2 comparing the liquid intake and output volume of treatment group and control group within 24 hours, in the first day, they were-374.88±100.13 ml and-274.88±55.54 ml respectivel,P<0.05. in the seventh day, they were-497.90±111.90 ml and-375.68±52.70 ml respectivel, P < 0.05, there was significant statistical different between them; 3 comparing baseline SBP of treatment group and control group,they were 98.70±10.54 and 95.60±4.71 mm Hg respectivel,in the first day, they were 102.32±10.54 and 98.75±13.33 mm Hg respectivel,in the seventh day,they were 104.84±14.14 and 103.42±5.66 mm Hg respectivel. Comparing the heart rate and blood pressure of the two groups, there was no significant statistical difference(P>0.05). comparing the heart rate, systolic blood pressure, diastolic blood pressure of treatment group with base line, there was no significant statistical difference(P >0.05),however, there was significant statistical difference in the control group(P<0.05);4 comparing the changes of serum ions of the two groups, in the seventh day,Serum sodium of treatment group and control group,they were142.47±3.80mmol/L and130.60±4.46mmol/L respectivel, there was significant statistical different between them(P<0.05). And they were 4.18±1.06mmol/Land 4.45±0.94mmol/L respective of Serum potassium,there was no significant statistical difference(P>0.05). 5 evaluating the congestive symptoms and signs of of the patients with heart failure in the two groups, the number of dyspnea, rale and orthopnea relieved patients that were treated by tolvaptan was obviously more than the control group, whatever there was no significant statistical difference in the first day(P > 0.05), there was significant statistical different in the seventh day(P<0.05). 6 comparing the kidney function indexes of the two groups, the baseline value of the BUN, Scr and e GFR has no statistic difference, after seven days’ treatment, the indexes in the treatment group kept within the normal limits while the serum creatinine concentration of the patients in the control group showed an increased tendency,there was significant statistical different(P<0.05). Compared with baseline of treatment group, there was no significant statistical difference(P>0.05), however, for control group, there was significant statistical difference(P<0.05); 7 comparing the left ventricular ejection fraction( LVEF), left ventricular end diastolic dimension(LVEDd),left ventricular end systolic diameter(LVEDs) 、 E/A and other ultrasonic cardiogram parameters and plasma NT-Pro BNP concentration of the two groups of patients after seven days’ treatment there was no significant statistical difference(P > 0.05); 8evaluating the adverse drug reactions in the two groups, the number of patients with thirst,frequent micturition symptoms in treatment group is more than the number in contrast group, however, for other adverse drug reactions and major adverse cardiac events( MACE) within 1month there was no statistic difference in the two groups.Conclusions The Tolvaptan is effective and safe for treating the patients with acute myocardial infarction accompanied by heart failure.