1088-128 Hemodynamic effects of intravenous nesiritide in patients with pulmonary hypertension

Michaels, Andrew D.; Chatterjee, Kanu; Madden, James A.; DeMarco, Teresa

doi:10.1016/s0735-1097(04)90815-7

Cited by 5 publications

(5 citation statements)

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“…Michaels et al reported the hemodynamic effects of intravenous nesiritide infusion in five patients with precapillary PH. 164 At 15 and 30 minutes following infusion, there was a decrease in systemic arterial pressure but no change in right-sided heart pressures or CO. Klinger et al found that a 3-hour BNP infusion alone, although well tolerated in adult patients with PAH, had no effect on mPAP or PVR. 165 However, the combination of sildenafil followed by BNP infusion caused a statistically significant reduction in both parameters that persisted for up to 6 h after stopping the BNP infusion ( Figure 6).…”

Section: Effect Of Bnp On Inflammation and Oxidative Stressmentioning

confidence: 91%

Brain natriuretic peptide in pulmonary arterial hypertension: biomarker and potential therapeutic agent

Casserly

Klinger²

2009

DDDT

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B-type natriuretic peptide (BNP) is a member of the natriuretic peptide family, a group of widely distributed, but evolutionarily conserved, polypeptide mediators that exert myriad cardiovascular effects. BNP is a potent vasodilator with mitogenic, hypertrophic and pro-inflammatory properties that is upregulated in pulmonary hypertensive diseases. Circulating levels of BNP correlate with mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with pulmonary arterial hypertension (PAH). Elevated plasma BNP levels are associated with increased mortality in patients with PAH and a fall in BNP levels after therapy is associated with improved survival. These findings have important clinical implications in that a noninvasive blood test may be used to identify PAH patients at high-risk of decompensation and to guide pulmonary vasodilator therapy. BNP also has several biologic effects that could be beneficial to patients with PAH. However, lack of a convenient method for achieving sustained increases in circulating BNP levels has impeded the development of BNP as a therapy for treating pulmonary hypertension. New technologies that allow transdermal or oral administration of the natriuretic peptides have the potential to greatly accelerate research into therapeutic use of BNP for cor pulmonale and pulmonary vascular diseases. This review will examine the basic science and clinical research that has led to our understanding of the role of BNP in cardiovascular physiology, its use as a biomarker of right ventricular function and its therapeutic potential for managing patients with pulmonary vascular disease.

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Section: Effect Of Bnp On Inflammation and Oxidative Stressmentioning

confidence: 91%

Brain natriuretic peptide in pulmonary arterial hypertension: biomarker and potential therapeutic agent

Casserly

Klinger²

2009

DDDT

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“…Our patient population was quite diverse, with multiple etiologies of PAH. Right heart catheters were not inserted, since hemodynamic monitoring was not clinically indicated—so the effects of nesiritide on pulmonary hemodynamics are uncertain in this series although they have been described by others 15 . The significant concern that the use of a vasoactive drug in patients with symptomatic pulmonary hypertension and cor pulmonale would be difficult required us to be cautious with the use of a preinfusion bolus of nesiritide or avoid the bolus altogether.…”

Section: Commentmentioning

confidence: 86%

“…Current treatment options for PAH include endothelin‐1 receptor antagonists, prostaglandin analogs, calcium channel blockers, chronic anticoagulation, and phosphodiesterase inhibitors targeted against phosphodiesterase 5. Recently, an infusion of nesiritide with a right‐sided cardiac catheter in place has been shown to decrease pulmonary artery pressure in patients with PAH and patients with pulmonary venous hypertension 15 …”

Section: Literature Reviewmentioning

confidence: 99%

Nesiritide for Pulmonary Arterial Hypertension With Decompensated Cor Pulmonale

Kingman

Thompson

Newkirk

et al. 2005

Progress Cardiovascular Nurs

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Pulmonary arterial hypertension complicated by decompensated cor pulmonale is a challenging clinical problem with few effective therapeutic options. B-type natriuretic peptide is a pluripotent hormone that promotes diuresis and natriuresis, vasodilates systemic and pulmonary vessels, and reduces circulating levels of endothelin and aldosterone. It may represent a possible therapeutic strategy for decompensated cor pulmonale in the same manner that it is used to treat decompensated left heart failure. The authors report their experience with B-type natriuretic peptide as adjunctive therapy for pulmonary arterial hypertension complicated by decompensated cor pulmonale. A detailed case report is presented followed by the evaluation of a series of 11 cases occurring in eight patients from December 2002 through April 2004.

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“…Michaels et al reported the hemodynamic effects of intravenous nesiritide infusion in five patients with precapillary PH. 60 At 15 and 30 minutes following infusion, there was a decrease in systemic arterial pressure but no change in right-sided heart pressures or CO. Kurian et al reported a patient in whom nesiritide infusion ameliorated the symptoms of severe PH due to rheumatic mitral valve disease that had been refractory to traditional therapy. 61 Neutral endopeptidase (NEP) is a major enzymatic pathway for the degradation of BNP and also plays a role in kinin and adrenomedulin breakdown.…”

Section: Prognosismentioning

confidence: 91%

Brain Natriuretic Peptide: Diagnostic and Therapeutic Implications in Pulmonary Arterial Hypertension

Hargett

Tapson²

2005

Seminars in Respiratory and Critical Care Medicine

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Brain or B-type natriuretic peptide (BNP) is one of the new biomarkers employed within the last decade to help clarify difficult cardiovascular problems. Plasma BNP is elevated in cardiac ventricular dysfunction and plays a key role in protecting the body from volume overload by maintaining renal function and sodium balance. Studies in patients with pulmonary arterial hypertension (PAH) have demonstrated that plasma BNP levels are raised proportionally to the extent of right ventricular (RV) dysfunction. There is growing evidence that BNP may be a potential biomarker for PAH in screening for occult disease, diagnostic evaluation, prognosis, and estimating a response to therapy. Additionally, augmentation of the natriuretic peptide system through exogenous administration of BNP or by preventing its degradation may be a promising option for the management of decompensated RV failure. Because plasma BNP levels rise in a variety of cardiopulmonary conditions and are affected by several physiological factors, BNP interpretation must not occur in isolation but rather within the context of good clinical judgment.

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1088-128 Hemodynamic effects of intravenous nesiritide in patients with pulmonary hypertension

Cited by 5 publications

References 0 publications

Brain natriuretic peptide in pulmonary arterial hypertension: biomarker and potential therapeutic agent

Brain natriuretic peptide in pulmonary arterial hypertension: biomarker and potential therapeutic agent

Nesiritide for Pulmonary Arterial Hypertension With Decompensated Cor Pulmonale

Brain Natriuretic Peptide: Diagnostic and Therapeutic Implications in Pulmonary Arterial Hypertension

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