| Objective: This prospective study was to compare the efficacy and safety of intravenous recompine human B-type natriuretic peptide(rhBNP) and nitroglycerin(NTG) in acute decompensated heart failure patients with acute anterior myocardial infarction.Methods: Twenty-four patients were admitted to our hospital from Dec. 2003 to Dec. 2004. Hemodynamic changes, including pulmonary capillary wedge pressure(PCWP), pulmonary artery pressure(PAP), central venous pressure(CVP), cardiac index(CI), were measured with right heart-catheter. Entry criteria required patients to have symptomatic heart failure with acute anterior myocardial infarction and meet PCWP≥18mmHg,CI≤2.7L/m~2/min. Patients with clinically important valvular stenosis, hypertrophic or restrictive cardiomyopathy, constrictive pericarditis, primary pulmonary hypertention or systolic blood pressure(SBP)<90mmHg were excluded from trial. 12 received rhBNP and 12 received NTG. The treatments were as follows: rhBNP given as a 1.5 μ g/kg intravenous bolus followed by an infusion of 0. 0075 μ g/kg/min.After 3 hours of treatment,the rhBNP dose could be increased to 0.015-0.030 μ g /kg/min. NTG dose was determined by the investigator and adjusted according to the clinical condition. Both drugs were administered for 24 hours. The administration of dobutamine, dopamine, and intravenous vasodilators was discontinued at least 30 minutes,and the administration of milrinone was discontinued at least 2 hours before the beginning of the study.Patients were excluded from the trial if they had already received an intravenous vasoactive agent for more than 4 hours. Patients were required to have a Swan-Ganz catheter in place to monitor the hemodynamic change. PCWP, PAP, CVP, CI, SBP were recorded 0,1/2,1,3,6,12,24,48 hours. In the trial, global clinical status and specific symptoms of congestive heart failure (dyspnea and fatigue) were assessed at baseline and at the end of therapy. Adverse eventes were recorded in 24 hours,including headache, nausea, abdominal windy, hypotention. All of these data were analysed by SAS 6.12 statistics software , P values of less than 0.05 were considered to indicate statistical significance.Results: Twenty-four patients were included . Seventy-five percent of the patients were male and the mean age was 66.4 + 6.1 years. Base-line demographic and clinical characteristics were similar between two groups including age, sex, accom-palication (high blood pressure, diabetes, hyperlipidemia), prei-nfarctional angina, cardiac enzyme peak and NYHA heart failure class. Hemodynamic assessment: There was no signifi-cant difference in baseline between rhBNP group and NTG group, mean PCWP were 23.4±3.9mmHg vs 24.5±3.3mmHg, P=0.47; mean PAP were 30.2+4.4 mmHg vs 30.2±4.2mmHg, P=\; mean CVP were 12.2±1.9mmHg vs 12.4 + 1.7 mmHg, P=0.73; mean CI were 2.06 + 0.12 L/min/m2 vs 2.11+0.12 L/min/m2, P=0.25. There was no significant difference in clinical symptoms,too. At 30 minutes after beginning of the treatment,PCWP was decreased 5.0 +1.7mm Hg(P<0.001) vs 2.1 + 1.0mmHg (PO.001) between rhBNP group and NTG group, and there was significant decreace to the beginning at 1, 3, 6, 12, 24, 48 hours in both groups. CI was measured at 0, 3, 24, 48 hour, in rhBNP group CI were 2.06 + 0.12/2.24 + 0.15/ 2.32 + 0.17/2.24 + 0.11 L/min/m2,and in NTG group CI were 2.11 ±0.12/2.21+0.15/2.22 + 0.16/2.19 + 0.12 L/min/m2, there were significant increase to the beginning. And effect of rhBNP was significantly better than NTG in PCWP and CI at the same time point. The same improvements could be found in CVP and PAP. Correpondingly the clinical symptoms were improved ,but there was no significant different between two groups. There were significant increases in urine output every 12 hours to the beginning, and the increase in rhBNP group was significantly more than in NTG group. Safety : the overall number of adverse events reported in the first 24 hours was similar between treatment groups. Headache, abdominal windy and nausea occurred more frequently in the NTG group. Dose-related hypotention occurred similarly in two groups, and these patients... |
PDF Full Text Request