Objective: The present study examined the efficacy and safety of torasemide in paediatric patients with chronic heart failure (HF).
Methods and Results: We analyzed 102 paediatric patients with chronic HF who received oral torasemide. Of these, 62 patients (De Novo Group) were newly diagnosed with HF and received torasemide as a diuretic therapy. The remaining 40 patients (Replacement Group) had been administered furosemide for >3 months before the study, and furosemide was then replaced with torasemide. Clinical signs and symptoms of HF (assessed as HF index), humoral factors, and serum potassium levels before torasemide treatment were compared with those obtained 3 to 4 weeks after torasemide treatment. Patients were also monitored for adverse effects. In the De Novo Group, torasemide significantly improved the HF index with a concomitant improvement in plasma brain natriuretic peptide (BNP) concentration [median (interquartile range); 52 (51) vs. 43 (49) pg/ml]. In randomly selected 25 De Novo patients with ventricular septal defect, echocardiography demonstrated that torasemide significantly improved left ventricular geometry and function. In the Replacement Group, BNP levels were also significantly decreased from 50 (104) to 45 (71) pg/ml after substitution of torasemide, while the HF index showed only a tendency for improvement (p=0.07). Torasemide also had a potassium-sparing effect (De Novo Group, no change in potassium levels; Replacement Group, significant increase from 4.2 (0.5) to 4.3 (0.5) mEq/l), and caused a significant rise in serum aldosterone levels, consistent with the anti-aldosterone effect of this drug. Serum levels of sodium and uric acid did not change after torasemide treatment, and there were no serious adverse events that necessitated drug withdrawal.
Conclusion: Torasemide can be safely used, and appears to be effective for treatment of HF in children. Future clinical trials are warranted to verify the present results.