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Systolic Blood Pressure at Admission as a Predictor of the Response to Initial Carperitide Therapy in Patients Hospitalized for Acute Decompensated Heart Failure with Left Ventricular Systolic Dysfunction

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Abstract

Purpose

In patients with acute decompensated heart failure (ADHF) and left ventricular systolic dysfunction (LVSD), the role of initial vasodilator therapy remains uncertain. The present study aimed to evaluate the acute efficacy of initial carperitide therapy and to predict its response in ADHF patients with LVSD.

Methods

Twenty-four consecutive patients with ADHF and LVSD were enrolled. Inclusion criteria were a left ventricular ejection fraction < 40%, systolic blood pressure (BP) > 90 mm Hg, and pulmonary capillary wedge pressure ≥18 mm Hg at baseline. Hemodynamic parameters were evaluated by right heart catheterization before and after carperitide infusion. Responders were defined as a ≥30% reduction of pulmonary capillary wedge pressure (PCWP) or a decrease to < 16 mm Hg within 6 h after carperitide infusion.

Results

Seventeen (71%) of the 24 patients were responders for initial carperitide therapy. The responders had significantly higher systolic BP and cardiac index at baseline compared with nonresponders. The area under the curve (AUC) for systolic BP was 0.93 and a cut-off value of 120 mm Hg had a sensitivity of 94% and specificity of 86% for predicting the efficacy of carperitide. The AUC for the cardiac index was 0.88 and a cut-off value of 2.30 L/min/m2 had a sensitivity of 65% and a specificity of 100% for predicting the response to carperitide.

Conclusions

The initial use of carperitide therapy safely reduces PCWP in ADHF patients with LVSD and baseline systolic BP may be useful for predicting the response to initial carperitide therapy for ADHF with LVSD.

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References

  1. Gheorghiade M, Zannad F, Sopko G, International Working Group on Acute Heart Failure Syndromes, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112:3958–68.

    Article  PubMed  Google Scholar 

  2. De Luca L, Mebazaa A, Filippatos G, et al. Overview of emerging pharmacological agents for acute heart failure syndromes. Eur J Heart Fail. 2008;10:201–13.

    Article  PubMed  Google Scholar 

  3. Nieminen MS, Harjola VP. Definition and epidemiology of acute heart failure syndromes. Am J Cardiol. 2005;96:5G–10G.

    Article  PubMed  Google Scholar 

  4. Mebazaa A, Gheorghiade M, Piña IL, et al. Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med. 2008;36:S129–S39.

    Article  PubMed  Google Scholar 

  5. Gheorghiade M, De Luca L, Fonarow GC, Filippatos G, Metra M, Francis GS. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96:11G–7G.

    Article  PubMed  Google Scholar 

  6. Metra M, Teerlink JR, Voors AA, et al. Vasodilators in the treatment of acute heart failure: what we know, what we don’t. Heart Fail Rev 2008. Published online ahead of print 19 December 2008

  7. Lee CYW, Burnett JC Jr. Natriuretic peptides and therapeutic applications. Heart Fail Rev. 2007;12:131–42.

    Article  CAS  PubMed  Google Scholar 

  8. Saito Y, Nakao K, Nishimura K, et al. Clinical application of atrial polypeptide in patients with congestive heart failure: beneficial effects on left ventricular function. Circulation. 1987;76:115–24.

    CAS  PubMed  Google Scholar 

  9. Colucci WS, Elkayam U, Horton DP, et al. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N Eng J Med. 2000;343:246–53.

    Article  CAS  Google Scholar 

  10. Publication Committee for the VMAC (Vasodilation in the management of acute CHF) Investigators. Intravenous nesiritide vs. nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287:1531–40.

    Article  Google Scholar 

  11. Elkayam U, Akhter MW, Singh H, Khan S, Usman A. Comparison of effects on left ventricular filling pressure of intravenous nesiritide and high-dose nitroglycerin in patients with decompensated heart failure. Am J Cardiol. 2004;93:237–40.

    Article  CAS  PubMed  Google Scholar 

  12. Suwa M, Seino Y, Nomachi Y, Matsuki S, Funahashi K. Multicenter prospective investigation on efficacy and safety of carperitide for acute heart failure in the ‘real world’ of therapy. Circ J. 2005;69:283–90.

    Article  PubMed  Google Scholar 

  13. Nomura F, Kurobe N, Mori Y, et al. Multicenter prospective investigation on efficacy and safety of carperitide as a first-line drug for acute heart failure syndrome with preserved blood pressure-COMPASS: Carperitide effects observed through monitoring dyspnea in acute decompensated heart failure study. Circ J. 2008;72:1777–86.

    Article  CAS  PubMed  Google Scholar 

  14. Nieminen MS, Böhm M, Cowie MR, et al. ESC Committe for Practice Guideline. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute heart Failure of the European Society of Cardiology. Eur Heart J. 2005;26:384–416.

    Article  PubMed  Google Scholar 

  15. Heart Failure Society of America. Executive summary: HFSA 2006 comprehensive heart failure practice guideline. J Card Fail. 2006;12:10–38.

    Article  Google Scholar 

  16. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur J Heart Fail. 2008;10:933–89.

    Article  PubMed  Google Scholar 

  17. Sackner-Bernstein JD, Skopicke HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation. 2005;111:1487–91.

    Article  CAS  PubMed  Google Scholar 

  18. Sackner-Bernstein JD, Kawalski M, Fox M, Aaronson KD. Short-term risk of death after treatment with nesiritide for decompensated heart failure. JAMA. 2005;293:1900–5.

    Article  CAS  PubMed  Google Scholar 

  19. Drazner MH, Hamilton MA, Fonarow G, Creaser J, Flavell C, Stevenson LW. Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. J Heart Lung Transplant. 1999;18:1126–32.

    Article  CAS  PubMed  Google Scholar 

  20. Larsen AI, Gøransson L, Aarsland T, Tamby JF, Dickstein K. Comparison of the degree of hemodynamic tolerance during intravenous infusion of nitroglycerin versus nicorandil in patients with congestive heart failure. Am Heart J. 1997;134:435–41.

    Article  CAS  PubMed  Google Scholar 

  21. Witteles RM, Kao D, Christopherson D, et al. Impact of nesiritide on renal function in patients with acute decompensated heart failure and pre-existing renal dysfunction. J Am Coll Cardiol. 2007;50:1835–40.

    Article  CAS  PubMed  Google Scholar 

  22. Serizawa T, Hirata Y, Kohmoto O, et al. Acute hemodynamic effects of alpha human atrial natriuretic polypeptide in patients with congestive heart failure. Jpn Heart J. 1988;29:143–9.

    CAS  PubMed  Google Scholar 

  23. Mizuno O, Onishi K, Dohi K, et al. Effects of therapeutic doses of human atrial natriuretic peptide on load and myocardial performance in patients with congestive heart failure. Am J Cardiol. 2001;88:863–6.

    Article  CAS  PubMed  Google Scholar 

  24. Cotter G, Williams SG, Vered Z, Tan LB. Role of cardiac power in heart failure. Curr Opin Cardiol. 2003;18:215–22.

    Article  PubMed  Google Scholar 

  25. Gheorghiade M, Abraham WT, Albert NM, et al. OPTIMIZE-HF Investigators and Coordinators. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296:2217–26.

    Article  CAS  PubMed  Google Scholar 

  26. Milo-Cotter O, Adams KF, O’Connor CM, et al. Acute heart failure associated with high admission blood pressure: a distinct vascular disorder? Eur J Heart Fail. 2007;9:178–83.

    Article  PubMed  Google Scholar 

  27. Mukoyama M, Nakao K, Hosoda K, et al. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest. 1991;87:1402–12.

    Article  CAS  PubMed  Google Scholar 

  28. Florkowski CM, Richards AM, Espiner EA, Yandle TG, Frampton C. Renal, endocrine, and hemodynamic interactions of atrial and brain natriuretic peptides in normal men. Am J Physiol. 1994;266:R1244–50.

    CAS  PubMed  Google Scholar 

  29. Hunt PJ, Espiner EA, Richards AM, Yandle TG, Frampton C, Nicholls MG. Interactions of atrial and brain natriuretic peptides at pathophysiological levels in normal men. Am J Physiol. 1995;269:R1397–R403.

    CAS  PubMed  Google Scholar 

  30. Kimura K, Yamaguchi Y, Horii M, et al. ANP is cleared much faster than BNP in patients with congestive heart failure. Eur J Clin Pharmacol. 2007;63:699–702.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgement

We express our appreciation to Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan) for expert statistical assistance.

Funding Source and Conflict of Interest Disclosures

There were no funding sources and no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Katsuya Kajimoto, Yukiko Sashida, Yuichiro Minami, Dai Yumino, Hirotaka Kawarai & Hiroshi Kasanuki

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  1. Katsuya Kajimoto
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  2. Yukiko Sashida
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  3. Yuichiro Minami
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  4. Dai Yumino
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Correspondence to Katsuya Kajimoto.

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Kajimoto, K., Sashida, Y., Minami, Y. et al. Systolic Blood Pressure at Admission as a Predictor of the Response to Initial Carperitide Therapy in Patients Hospitalized for Acute Decompensated Heart Failure with Left Ventricular Systolic Dysfunction. Cardiovasc Drugs Ther 23, 481–488 (2009). https://doi.org/10.1007/s10557-009-6207-2

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