Document Detail


B-type natriuretic peptide infusions in acute myocardial infarction.
MedLine Citation:
PMID:  17639095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Natriuretic peptides have actions likely to ameliorate cardiac dysfunction. B-type natriuretic peptide (BNP) is indicated as treatment for decompensated cardiac failure. OBJECTIVE: To determine the utility of BNP in acute myocardial infarction (MI). DESIGN: Double-blind randomised placebo-controlled trial. SETTING: Tertiary hospital coronary care unit. PATIENTS: 28 patients with acute MI with delayed or failed reperfusion and moderate left ventricular dysfunction. INTERVENTIONS: Infusion of BNP or placebo for 60 hours after MI. MAIN OUTCOME MEASURES: Neurohormonal activation and renal function in response to BNP infusion, secondary end points of echocardiographic measures of left ventricular function and dimension. RESULTS: BNP infusion resulted in a significant rise in BNP (276 pg/l vs 86 pg/l, p = 0.001). NT-proBNP levels were suppressed by BNP infusion (p = 0.002). Atrial natriuretic peptide (ANP) and NT-proANP levels fell with a significant difference in the pattern between BNP infusion and placebo during the first 5 days (p<0.005). C-type natriuretic peptide (CNP) and NT-proCNP levels rose during the infusion with higher levels than placebo at all measurements during the first 3 days (p<0.01). Cyclic guanosine monophosphate (cGMP) was raised during the infusion period showing a peak of 23 pmol/l on day 2 (placebo 8.9 pmol/l, p = 0.002), with a correlation between BNP and cGMP levels (p<0.001). Glomerular filtration rate (GFR) fell with BNP infusion but was not significantly lower than with placebo (71.0 (5.6) vs 75.8 (5.4) ml/min/1.73 m2, p = 0.62). Patients receiving nesiritide exhibited favourable trends in left ventricular remodelling. CONCLUSIONS: Nesiritide, given soon after MI, induced increments in plasma cGMP and CNP and decrements in other endogenous cardiac peptides with a neutral effect on renal function and a trend towards favourable ventricular remodelling.
Authors:
R J Hillock; C M Frampton; T G Yandle; R W Troughton; J G Lainchbury; A M Richards
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-07-16
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  94     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-15     Completed Date:  2008-05-02     Revised Date:  2009-07-30    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  617-22     Citation Subset:  AIM; IM    
Affiliation:
Christchurch Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences and Christchurch Hospital, Christchurch, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Natriuretic Factor / blood
Coronary Artery Disease / blood,  drug therapy*
Cyclic GMP / metabolism*
Dose-Response Relationship, Drug
Double-Blind Method
Echocardiography, Doppler, Pulsed / methods
Female
Follow-Up Studies
Humans
Kidney / drug effects
Male
Middle Aged
Myocardial Infarction / blood,  drug therapy*
Natriuretic Agents / administration & dosage*
Natriuretic Peptide, Brain / administration & dosage*,  blood
Peptide Fragments / blood
Receptors, Atrial Natriuretic Factor / administration & dosage*,  blood
Chemical
Reg. No./Substance:
0/Natriuretic Agents; 0/Peptide Fragments; 0/brain natriuretic peptide receptor; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 7665-99-8/Cyclic GMP; 85637-73-6/Atrial Natriuretic Factor; EC 4.6.1.2/Receptors, Atrial Natriuretic Factor
Comments/Corrections
Comment In:
Heart. 2008 May;94(5):542-4   [PMID:  18411344 ]

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