Vasodilators in acute heart failure - evidence based on new studies

Travessa, André; Falcão, Luiz Menezes

doi:10.1016/j.ejim.2018.02.020

Cited by 12 publications

(10 citation statements)

References 65 publications

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“…14,31,37,38 The frequency of intravenous vasodilators, such as nitrates, in our study was similar to that reported by the EHFS II. 39 Furthermore, the superior cost-effectiveness of carperitide has not been demonstrated. 37,38 The usage rates of natriuretic peptides were 30% in our study, 34% in the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD), and up to 69% in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry.…”

Section: Hospital Treatment and Prognosismentioning

confidence: 99%

“…Haematocrit (%) 36 [32][33][34][35][36][37][38][39][40] 38 [33][34][35][36][37][38][39][40][41][42] 35 [32][33][34][35][36][37][38][39][40] 34 [31][32][33][34][35][36][37][38] <0.001…”

mentioning

confidence: 99%

“…14,38 Carperitide, a natriuretic peptide that is only approved in Japan, has been evaluated as a treatment for acute decompensated HF in only a few trials that have assessed mortality. 39 Furthermore, the superior cost-effectiveness of carperitide has not been demonstrated. 40 The use of carperitide for HF treatment may need to be reconsidered.…”

mentioning

confidence: 99%

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Clinical characteristics of hospitalized heart failure patients with preserved, mid‐range, and reduced ejection fractions in Japan

et al. 2019

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Aims There are regional differences in the patient characteristics, management, and outcomes of hospitalized patients with heart failure (HF). The aim of this study was to evaluate the clinical characteristics and outcomes of Japanese patients who are hospitalized with HF on the basis of the left ventricular ejection fraction (LVEF) stratum. Methods and results We retrospectively conducted a multicentre cohort study of 1245 hospitalized patients with decompensated HF between 2013 and 2014. Of these patients, 36% had an LVEF < 40% [HF with reduced ejection fraction (HFrEF), median age 72 years, 71% male], 21% had an LVEF 40–49% [HF with mid‐range EF (HFmrEF), 77 years, 56% male], and 43% had an LVEF ≥ 50% [HF with preserved EF (HFpEF), 81 years, 44% male]. The primary outcome was death from any cause, and the secondary outcomes were cardiac death and re‐hospitalization due to worsened HF after hospital discharge. There were high proportions of non‐ischaemic cardiomyopathy (32%) in HFrEF patients, coronary artery disease (44%) in HFmrEF patients, and valvular disease (39%) in HFpEF patients. The frequencies of intravenous diuretic and natriuretic peptide administration during hospitalization were 66% and 30%, respectively. The median hospital stay for the overall population was 19 days, and the length of stay was >7 days for >90% of patients. In‐hospital mortality was 7%, but was not different among the LVEF groups (HFrEF 7%, HFmrEF 6%, and HFpEF 8%). After a median follow‐up of 19 months (range, 3–26 months), 192 (17%) of the 1156 patients who were discharged alive died, and 534 (46%) were re‐hospitalized after hospital discharge. There were no significant differences in mortality after hospital discharge among the three LVEF groups (HFrEF 18%, HFmrEF 16%, and HFpEF 16%). There were no differences in cardiac death or re‐hospitalization due to worsened HF after hospital discharge among the LVEF groups (cardiac death: HFrEF 8%, HFmrEF 7%, and HFpEF 7%; re‐hospitalization due to worsened HF: HFrEF 19%, HFmrEF 16%, and HFpEF 17%). Multivariable‐adjusted analyses showed that the HFmrEF and HFrEF groups, compared with the HFpEF group, were not associated with an increased risk for in‐hospital death or death after hospital discharge. Non‐cardiac causes of death and re‐hospitalization after hospital discharge accounted for 35% and 38%, respectively. Conclusions Our results revealed different clinical characteristics but similar mortality rates in the HFrEF, HFmrEF, and HFpEF groups. The most common cause of death and re‐hospitalization after hospital discharge was HF, but non‐cardiac causes also contributed to their prognosis. Integrated management approaches will be required for HF patients.

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Section: Hospital Treatment and Prognosismentioning

confidence: 99%

“…Haematocrit (%) 36 [32][33][34][35][36][37][38][39][40] 38 [33][34][35][36][37][38][39][40][41][42] 35 [32][33][34][35][36][37][38][39][40] 34 [31][32][33][34][35][36][37][38] <0.001…”

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confidence: 99%

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Clinical characteristics of hospitalized heart failure patients with preserved, mid‐range, and reduced ejection fractions in Japan

et al. 2019

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“…The rationale behind using NPs as a therapeutic target in HF therapy [45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62] resides in the seemingly abnormal BNP processing with a subsequent deficiency in active forms and resistance to their biological effects in these patients [5]. It seems that HF patients are deficient in biologically active BNP32 with a subsequent increase in BNP1–108 [45].…”

Section: Therapeutic Implications Of Natriuretic Peptides In Heartmentioning

confidence: 99%

“…A different NP used in HF treatment is carperitide, a recombinant form of ANP. Although recommended in Japan for acute HF therapy, it has failed to enter either ESC or American guidelines, especially because of limited studies and decreased half-life [5,51]. Despite improving symptoms in the studied Japanese population, there was no impact reported on mortality.…”

Section: Therapeutic Implications Of Natriuretic Peptides In Heartmentioning

confidence: 99%

Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications

Tănase

Radu

Shurbaji

et al. 2019

IJMS

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The incidence of heart failure with preserved ejection fraction (HFpEF) is increasing and its challenging diagnosis and management combines clinical, imagistic and biological data. Natriuretic peptides (NPs) are hormones secreted in response to myocardial stretch that, by increasing cyclic guanosine monophosphate (cGMP), counteract myocardial fibrosis and hypertrophy, increase natriuresis and determine vasodilatation. While their role in HFpEF is controversial, most authors focused on b-type natriuretic peptides (BNPs) and agreed that patients may show lower levels. In this setting, newer molecules with an increased specificity, such as middle-region pro-atrial natriuretic peptide (MR-proANP), emerged as promising markers. Augmenting NP levels, either by NP analogs or breakdown inhibition, could offer a new therapeutic target in HFpEF (already approved in their reduced EF counterparts) by increasing the deficient cGMP levels found in patients. Importantly, these peptides also retain their prognostic value. This narrative review focuses on NPs’ physiology, diagnosis, therapeutic and prognostic implication in HFpEF.

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New cimlanod trial provides insights into mechanistic effects of vasodilators in heart failure

Collins,

Ngo,

Sverdlov

2023

European J of Heart Fail

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This article refers to 'Impact of vasodilators on diuretic response in patients with congestive heart failure: A mechanistic trial of cimlanod (BMS-986231)' by P. Pellicori et al., published in this issue on pages 142-151.Heart failure (HF) is a clinical syndrome with wide range of aetiologies and underlying pathophysiological processes, making it a challenging disease entity to manage effectively. One of the hallmark features in many patients with both acute and chronic HF is pulmonary and systemic congestion due to salt and water retention. There have been numerous clinical trials evaluating medical therapies for chronic HF that have shown significant improvements in outcomes and these have translated into the latest guidelines. 1-3 These strategies have broadly targeted renin-angiotensin-aldosterone system, neurohormonal activation and energetic efficiency, yet none of these strategies target congestion directly.The HF guidelines recommend use of diuretics in the presence of congestion, 1,2 and indeed loop diuretics, cornerstone treatment for water and salt retention, are amongst the most commonly used HF therapies, generally outperforming guideline-directed medical therapies that have a survival advantage. While mortality benefit has not been demonstrated in clinical trials for diuretic use in chronic HF, failure to achieve effective diuresis is generally associated with worse prognosis in HF. Prompt relief of symptoms of congestion, complicating volume overload in the setting of acute decompensation, remains a critical cornerstone of clinical cardiac failure management. 4 Despite the obvious need for effective therapies, there remains a paucity of data to inform approaches to decongestion in patients with fluid overload beyond the use of loop diuretic therapy. While the use of loop diuretic agents continues to form the basis of current management, further progress in this area remains of major interest. This observation is reflected in recent studies addressing the use of acetazolamide in this patientThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Vasodilators in acute heart failure - evidence based on new studies

Cited by 12 publications

References 65 publications

Clinical characteristics of hospitalized heart failure patients with preserved, mid‐range, and reduced ejection fractions in Japan

Clinical characteristics of hospitalized heart failure patients with preserved, mid‐range, and reduced ejection fractions in Japan

Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications

New cimlanod trial provides insights into mechanistic effects of vasodilators in heart failure

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