Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial

Abstract

Background: Recent reports suggest that torasemide might be more beneficial than furosemide in patients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide and furosemide on clinical outcomes in HF patients.

Methods: This study pilot consisted of data from the ongoing multicenter, randomized, unblinded endpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association (NYHA) II-IV class with a stable dose of furosemide were randomized to treatment with equipotential dose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment and control visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) and assessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint was a composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decrease in fluid retention of at least 0.5 W after 3-months follow-up.

Results: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up 7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients). The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively (p = 0.03).

Conclusions: In HF patients treated with torasemide fluid overload and symptoms improved more than in the furosemide group. This positive effect occurred already within 3-month observation.

Keywords: heart failure; hospitalization; loop diuretics; prognosis; symptoms.

Figure 1

Flow chart of patient enrollment in the study; CHF — congestive heart failure; NYHA — New York Heart Association; 6MWT — six-minute walking test.

Figure 2

Changes in New York Heart Association (NYHA) functional class from baseline to the end of follow-up. The proportion of patients with/without NYHA class improvement (≥ 1 NYHA class) from baseline to the end of 3-month follow-up in torasemide-treated patients (p = 0.77 compared to furosemide-treated patients).

Figure 3

Changes in six-minute walk test (6MWT) from baseline to the end of follow-up. The proportion of patients with/without improvement in walking distance (≥ 50 m) during 6MWT from baseline to the end of 3-month follow-up in torasemide-treated patients (p = 0.09 compared to furosemide-treated patients).

Figure 4

Changes in fluid retention from baseline to the end of follow-up. The proportion of patients with/without decrease (≥ 0.5 Ω) in fluid retention from baseline to the end of 3-month follow-up in torasemide-treated patients (p = 0.51 compared to furosemide-treated patients).