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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Acute decompensated heart failure (ADHF) is a common cause of hospital admission. Standard management involves optimizing oxygen therapy and achieving adequate diuresis However, the use of conventional diuretics may be limited by the risk of worsening renal function. The coexistence of acute kidney injury at presentation, often as part of the cardiorenal syndrome, or the development of renal impairment during treatment, can complicate management, prolong oxygen dependency, and extend hospitalization. Tolvaptan, a selective vasopressin V2 receptor antagonist, promotes aquaresis without significant electrolyte loss and has been proposed as an adjunctive therapy in ADHF to enhance decongestion while minimizing renal compromise.
This is a single-center, open-label, case-controlled clinical trial, involving all patients admitted to our center for ADHF from 1st December 2024 to 31st May 2025. We included all patients with age of 18 years and above, excluding those with end-stage kidney disease (ESKD) or chronic kidney disease (CKD) stage 5, and those who required invasive mechanical ventilation within six hours of presentation. We aimed to determine the in-hospital outcomes of adjunctive tolvaptan therapy at six hours of ADHF presentation and the predictors of tolvaptan effectiveness.
66 patients were recruited, with a mean (± standard deviation) age of 64.6 ± 14.7 years. There was a slight predominant male sex (53.0%) and Malay ethnicity (43.9%). By block randomization, 35 patients were given adjunctive therapy with 7.5 mg tolvaptan at six hours of ADHF presentation, and the remaining 31 patients received only the conventional diuretic therapy. Early adjunctive therapy with tolvaptan was able to improve dyspneic symptoms in 24 hours measured by the improvement of heart failure likert scale [-3.0 (1.0) in tolvaptan vs -2.0 (3.0) in non-intervention, p<0.001] with significant urine output first 24 hours [3100.0 (2000.0) ml in tolvaptan vs 1500.0 (1350.0) ml in non-intervention, p<0.001]. Notably, early adjunctive therapy with tolvaptan reduced worsening renal function [11.4% in tolvaptan vs 38.7% in non-intervention, p=0.020], duration of oxygen support [2.0 (2.0) days in tolvaptan vs 4.0 (3.0) days in non-intervention, p<0.001], and duration of hospital stays [5.0 (4.0) days in tolvaptan vs 6.0 (4.0) days in non-intervention, p=0.030].
Sub-analysis excluding non-intervention arm in order to explore the predictors of tolvaptan effectiveness in ADHF revealed that the use of tolvaptan in non-CKD as compared to CKD patients can reduce the incidence of worsening renal function by 71.5% [OR 0.285, p=0.022 (Table 1)]. However, there was no predictor of tolvaptan effectiveness identified in reduction of durations of oxygen support and hospital stay due to statistical insignificant.
Early adjunctive therapy with tolvaptan in ADHF significantly improved early symptom relief and diuresis, while reducing the incidence of worsening renal function, duration of oxygen support, and length of hospital stay. Subgroup analysis suggests that patients without underlying CKD derive greater renal protective benefit from tolvaptan.
