Brain Natriuretic Peptide (Nesiritide) in the Treatment of Heart Failure

Abstract

Over the last decade brain natriuretic peptide (BNP) emerged as a cardiac hormone of clinical interest in diagnosis, prognosis and treatment of patients with Heart Failure (HF). The diagnostic potential of BNP is now well established both in patients with suspected HF as well as in patients with asymptomatic left ventricular systolic dysfunction. The prognostic information obtained from BNP levels in HF and acute myocardial infarction patients seems even more promising.Nesiritide is a synthetic peptide, homologous to endogenous BNP. It is a balanced vasodilator with diuretic and natriuretic properties. It decreases the elevated levels of neurohormones resulting from activation of the sympathetic and renin-aldosterone systems in HF. The results of clinical trials involving more than 2000 patients with decompensated HF are now available. In these trials nesiritide was administered by single or repeated bolus injections, as well as by sustained infusions.Nesiritide has been shown to produce a potent, dose-related vasodilator effect that is rapid in onset and sustained during infusion. Balanced vasodilation is reflected by decreases in systemic vascular resistance, pulmonary artery wedge pressure and right atrial pressure. No tachyphylaxis has been observed in these trials. Efficacy of nesiritide in the treatment of decompensated HF has been demonstrated. Trials comparing nesiritide with conventional treatment of decompensated HF showed that nesiritide compares favorably to standard agents. The safety profile has been excellent with a dose-dependent hypotension as the major side effect. Ventricular arrhythmia was not more frequent in patients treated with nesiritide than with placebo. Thus, nesiritide appears to be useful as a firstline agent in the treatment of patients with decompensated HF.

Nocturia as a manifestation of systemic disease

“…Ionic solute shifts similarly contribute to the third‐space effects. Atrial natriuretic peptide (ANP) and brain natriuretic peptide are significantly increased in patients with congestive heart failure, exaggerating the fluid shifts seen [34,35]. Third‐space sequestration occurs in cardiac impairment, autonomic neuropathy, renal impairment, nephrotic syndrome, hepatic failure, malnutrition, and venous stasis due to chronic venous insufficiency.…”

Natriuretic Peptides as an Adjunctive Treatment for Acute Myocardial Infarction

“…Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) have been approved to treat heart failure. 1,2) They share similar biological actions such as suppressing the renin-angiotensin-aldosterone system and sympathetic system. 3) Previous experimental studies revealed that natriuretic peptide infusion could limit myocardial infarct size and prevent reperfusion arrhythmia in myocardial ischemia-reperfusion injured rats.…”

“…Vol 55 No 1 NATRIURETIC PEPTIDES THERAPY FOR AMI BNP infusion with control groups in patients with AMI; (2) diagnosis of AMI: ST-segment elevated myocardial infarction (STEMI) was defi ned as typical clinical presentation, ST-segment elevation (> 0.2 mV elevation in two or more adjacent precordial leads, or > 0.1 mV in adjacent limb leads) and a rise in plasma cardiac markers; non-ST-segment elevated myocardial infarction was defi ned as typical clinical presentation and elevation of plasma cardiac markers, with no ST-segment elevation on ECG; (3) data on myocardial infarction size, left ventricular ejection fraction (LVEF), or major adverse cardiovascular events (MACEs). Studies without reports of relevant clinical outcomes were excluded.…”

Sacubitril/Valsartan and Ivabradine: Two Compounds for Heart Failure with Low Ejection Fraction (EFrEF), Acting by Innovative Mechanisms

“…Its action on veins induces an increase of venous capacitance and thereby lowers left and right heart filling pressures. Thus, the rationale for its use in HF is based on both hemodynamic effects [18] . Tolvaptan is an oral vasopressin V 2 receptor antagonist, able to induce a clearance of free water.…”