Clinical InvestigationCongestive Heart FailureEffect of nesiritide in combination with standard therapy on serum concentrations of natriuretic peptides in patients admitted for decompensated congestive heart failure
Section snippets
Patients
This prospective study was carried out at the San Diego Veterans Affairs Healthcare System between July 2001 and June 2002. Patients requiring hospitalization and intravenous therapy for decompensated CHF were considered for inclusion if they had dyspnea at rest or with minimal activity, clinical evidence of heart failure as the primary etiology of dyspnea, and a BNP level >100 pg/mL. Nineteen men between the ages of 42 and 80 were included in this study. The UCSD Institutional Review Board
Results
Patient characteristics are shown in Table I. The mean age of the patients was 65 years (range 42-80 years) with a preponderance of ischemic cardiomyopathy as the etiology of CHF. Seventy-four percent of the patients were white and the average ejection fraction was 35%. Forty-two percent of the subjects had CHF for 1 to 5 years before therapy. Ninety percent of the patients had jugular venous distension, 79% had rales, and 79% had edema.
All but one subject completed the nesiritide infusion
Discussion
B-type natriuretic peptide has been called the “emergency” cardiac hormone, synthesized in a futile attempt to stave off the large surges by the vasoconstrictor and salt-retaining hormones released during decompensation.17 Nesiritide is metabolized and eliminated via the same pathways as endogenous BNP. These pathways include binding to natriuretic peptide clearance receptors present throughout the vasculature, followed by endocytosis and intracellular lysosomal hydrolysis, proteolytic
References (21)
- et al.
Resource Utilization Among Congestive Heart Failure (REACH) Study. Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (R.E.A.C.H.) study
J Am Coll Cardiol
(2002) - et al.
Systemic hemodynamic, neurohormonal, and renal effects of a steady-state infusion of human brain natriuretic peptide in patients with hemodynamically decompensated heart failure
J Card Fail
(1998) - et al.
A rapid bedside test for peptide (BNP) predicts treatment outcomes in patients admitted for decompensated heart failure
J Am Coll Cardiol
(2001) - et al.
Preliminary data on the potential usefulness of B-type natriuretic peptide levels in predicting outcome after hospital discharge in patients with heart failure
Am J Med
(2002) - et al.
A rapid test for B-type natriuretic peptide (BNP) correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study
J Card Fail
(2001) - et al.
Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction
Am Heart J
(1998) Heart disease and stroke statistics—2003 update
(2002)- et al.
Economic impact of heart failure in the United States
J Heart Lung Transplant
(1994) Intravenous nesiritide versus nitroglycerin for the treatment of decompensated congestive heart failure—a randomized controlled trial
JAMA
(2002)Pharmacologic therapies for acutely decompensated heart failure
Rev Cardiovasc Med
(2002)
Cited by (31)
Targeting Cyclic Guanosine Monophosphate to Treat Heart Failure: JACC Review Topic of the Week
2020, Journal of the American College of CardiologyCitation Excerpt :In a study of 2,157 patients with AHF, ularitide more rapidly reduced the N-terminal fraction of pro-BNP (NT-proBNP) but did not reduce cardiovascular mortality (40). The recombinant BNP nesiritide was shown to cause an up to 3-fold increase in BNP levels (41) and to reduce pulmonary capillary wedge pressure (PCWP) and dyspnea in AHF (42), although its use has been criticized given the increase in symptomatic hypotension, worsening of renal function, and no beneficial effects on clinical status, hospitalization, or mortality (43,44). The OVERTURE (Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events) study randomized 5,770 patients with HFrEF to receive the dual NEP and ACE inhibitors omapatrilat or enalapril (45).
NT-proBNP is a potential mediator between reduced ejection fraction and depression in patients with heart failure
2018, Journal of Psychiatric ResearchCitation Excerpt :Exploring the association of NT-proBNP levels and depression in these outlier groups with clarifications on variables such as dietary factors, physical activity as well as more in-depth description on renal function to factor into our analysis may provide better insight in our current mediation findings. Furthermore, considering the impact of the infusion of the drug Nesiritide (synthetic BNP) in patients with HF, which was not associated with any acknowledged depressive side effects during 48-h infusion (Fitzgerald et al., 2005; Mentzer et al., 2007; Weeks, 2008), may also add support for mediation versus association. Lastly, it is possible that depressive symptoms may reflect clinical or subclinical disease process and to overcome this obstacle, we adjusted the analysis for factors such as age, sex and HF etiology to avoid false-positive outcomes.
Levosimendan and nesiritide as a combination therapy in patients with acute heart failure
2015, American Journal of the Medical SciencesCitation Excerpt :For each parameter, improvement was defined as a decrease of 1 or more classes from the baseline values. The treatment was considered clinically effective if (1) improvement was observed in 1 or more parameters, (2) all other parameters remained unchanged and (3) the therapy was not accompanied by any of the following situations: the addition of diuretics to achieve adequate urine output, the administration of inotrope, vasopressor or increases in their previous doses or the need for hemodynamic or ventilatory mechanical support.19 The secondary outcomes included improvements in dyspnea at the 1st and 3rd day after the start of the infusion, improvements in NYHA classifications at 1, 3, 5 and 9 days after the start of infusion, reductions in BNP levels and changes in the LVEF between baseline and 5 days, the incidences of significant hypotension, SVT or VF, new-onset atrial fibrillation and worsening renal function at 5 days, and death during the first 9 days and 3 months.
Lack of evidence for intravenous vasodilators in ED patients with acute heart failure: A systematic review
2015, American Journal of Emergency MedicineCitation Excerpt :Several studies have confirmed its ability to significantly reduce PCWP [17,20–23]. The use of nesiritide in patients with AHF is also associated with reductions in endogenously produced BNP, a laboratory value used clinically as a surrogate for cardiovascular congestion [24,25]. Several small studies have shown a benefit of adding nesiritide to standard therapy on patient-reported relief of dyspnea [20,26], but additional studies provided little support for nesiritide in reducing the frequency of rehospitalization [27–34] or mortality [26–28] in patients with AHF (Table 1).
Renal function and neurohormonal changes following intravenous infusions of nitroglycerin versus nesiritide in patients with acute decompensated heart failure
2011, Journal of Cardiac FailureCitation Excerpt :In a prospective study, nesiritide significantly lowered NT-proBNP levels at 24 hours after initiation and 12 hours after infusion compared with baseline (P < .05). Similarly, BNP levels were significantly reduced after nesiritide infusions (P < .05).16 Conversely, nitroglycerin has been shown to induce neurohormonal activation.13,17
Brain natriuretic peptide (BNP) as a biomarker of myocardial ischemia-reperfusion injury in cardiac transplantation
2010, Journal of Cardiothoracic and Vascular Anesthesia