Acute and chronic effects of a diuretic monotherapy with piretanide in congestive heart failure--a placebo-controlled trial.

To evaluate the acute and chronic effects of diuretic monotherapy with 3 mg piretanide bid, 46 patients (pts) with congestive heart failure (NYHA II-III) secondary to coronary artery disease were studied. Within 3 weeks of therapy, the patients lost 1.6 kg body weight. Forty-four patients reported a subjective feeling of improvement. Echocardiographically, a highly significant (p less than 0.001) reduction of diastolic and systolic diameters was found, as well as an increase of fraction shortening. Chest x-ray indicated a reduction of heart volume from 1012 +/- 263 ml to 936 +/- 233 ml (p less than 0.001). The serum potassium level remained unchanged. A subgroup of 26 pts underwent invasive hemodynamic examinations. IV injection of 6 mg piretanide resulted in an acute reduction of pulmonary wedge pressure (pc) from 20.2 +/- 5.3 mmHg to 11.9 +/- 5.0 mmHg (p less than 0.001); simultaneously a slight decrease of cardiac index from 3.2 +/- 0.6 l/min/m2 to 3.0 +/- 0.4 l/min/m2 was observed. Invasive control after 3 weeks of oral therapy showed no decline of the piretanide effect. The exercise tolerance increased clearly from 135 +/- 161 Wmin to 249 +/- 268 Wmin (p less than 0.05). A control group of further 14 pts was treated with placebo only and did not show any significant changes of pc (20.0 +/- 6.4 mmHg vs. 22.8 +/- 19.2 mmHg), exercise tolerance, or other clinical parameters. Thus, the diuretic monotherapy of congestive heart failure with piretanide is highly effective and shows a significant improvement in all clinical and hemodynamic parameters in the absence of any remarkable side effects.
AuthorsW Haerer, U Bauer, N Sultan, K Cernoch, N Mouselimis, K J Fehske, M Hetzel, M Stauch, V Hombach
JournalCardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy (Cardiovasc Drugs Ther) Vol. 4 Issue 2 Pg. 515-21 (Apr 1990) ISSN: 0920-3206 [Print] UNITED STATES
PMID2285635 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Diuretics
  • Sulfonamides
  • piretanide
  • Adult
  • Aged
  • Catheterization, Swan-Ganz
  • Diuretics (administration & dosage, therapeutic use)
  • Echocardiography (drug effects)
  • Exercise Test (drug effects)
  • Female
  • Heart Failure (drug therapy, radiography)
  • Hemodynamics (drug effects)
  • Humans
  • Male
  • Middle Aged
  • Single-Blind Method
  • Sulfonamides (administration & dosage, therapeutic use)
  • Time Factors

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