Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2019-12-09

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

Paweł Balsam1, Krzysztof Ozierański1, Michał Marchel1, Monika Gawałko1, Łukasz Niedziela1, Agata Tymińska1, Bartosz Sieradzki1, Maciej Sieradzki1, Anna Fojt1, Elwira Bakuła2, Renata Główczyńska1, Michał Peller1, Maciej Markulis1, Janusz Bednarski2, Robert Kowalik1, Andrzej Cacko1, Grzegorz Niewiński3, Krzysztof J. Filipiak1, Grzegorz Opolski1, Marcin Grabowski1
Pubmed: 31909470
Cardiol J 2019;26(6):661-668.


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.

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