Effects of Increased Dose of Diuretics on Symptoms, Weight, 6-Minute Walk Distance, and Echocardiographic Measurements of Left Ventricular Systolic and Diastolic Function in 51 Patients With Symptomatic Heart Failure Caused by Reduced Left Ventricular Ejection Fraction Treated With Beta Blockers and Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers

We investigated in 51 consecutive outpatients with symptomatic congestive heart failure caused by abnormal left ventricular (LV) ejection fraction treated with furosemide or torsemide (10% also with metolazone), beta blockers, and angiotensin-converting enzyme Inhibitors or angiotensin receptor blockers, 55% with spironolactone, and 18% with digoxin, the effects of doubling the dose of furosemide, torsemide, and metolazone on symptoms, weight, 6-minute walk distance, and echocardiographic measurements of LV systolic and diastolic function at 24 +/- 6 days follow-up. At follow-up, the weight decreased from 70 +/- 6 kg to 65 +/- 6 kg (P < 0.001), the New York Heart Association functional class decreased from 2.9 +/- 0.4 to 2.1 +/- 0.2 (P < 0.001), the Minnesota With Heart Failure Questionnaire score decreased from 43 +/- 7 to 28 +/- 8 (P < 0.001), the 6-minute walk distance increased from 270 +/- 46 m to 318 +/- 44 m (P < 0.001), and there was no significant change in LV ejection fraction, LV end-diastolic dimension, LV end-systolic dimension, left atria] dimension, pulmonary artery systolic pressure, peak mitral early/atrial ratio, mitral deceleration time, and velocity time interval. In conclusion, doubling the dose of diuretics in outpatients with symptomatic congestive heart failure caused a significant loss of weight and a significant improvement in symptoms and 6-minute walk distance but did not change LV systolic and diastolic function.