| Biomarker responses during and after treatment with nesiritide infusion in patients with decompensated chronic heart failure. | |
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MedLine Citation:
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PMID: 15615816 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Objective methods to assess the adequacy of medication therapy for patients with advanced heart failure are lacking. Serial measurements of biomarkers might be beneficial. Therapy guided by N-terminal pro-B-type natriuretic peptide (NT-proBNP) might be helpful because NT-proBNP should be lowered by therapies that decrease endogenous BNP secretion. METHODS: NT-proBNP and BNP were measured in a nonconsecutive patient cohort receiving clinically indicated intravenous nesiritide. Blood samples were drawn before, at 6 and 24 h during, and at 6 h after infusion. A reduction in NT-proBNP was defined as a decrease from baseline during infusion ("infusion responders") of >3 SD of the variability of the assay measurement (approximately 20%). Patients with decreases >20% in both NT-pro BNP and BNP at 6 h post infusion were designated "biochemical responders". RESULTS: Forty patients [27 males; mean (SE) age, 68 (2) years; mean (SE) left ventricular ejection fraction, 25 (1.4)%] were studied. All patients improved clinically. Overall, the changes in NT-proBNP were a 18 (4.6)% [mean (SE)] and 19.8% (median) decrease from baseline at 24 h of infusion and a 22 (6.0)% and 17.8% decrease at 6 h post infusion (P <0.001 compared with baseline). In a large number of patients, decreases in NT-proBNP were, however, within the variability of the assay. Subgroup analysis showed that 22 of 40 patients were infusion responders with a >20% decrease from baseline in NT-proBNP during nesiritide infusion, whereas only 12 patients were biochemical responders with >20% decreases from baseline postinfusion for both NT-proBNP and BNP. CONCLUSIONS: In this study, many patients had decreased NT-proBNP and BNP values after therapy with nesiritide, but the majority of patients did not demonstrate biochemically significant decreases in analytes despite a clinical response. Until we know more about the responses of natriuretic peptides to therapies such as nesiritide, a strategy of monitoring NT-proBNP and BNP to guide therapy cannot be universally advocated. |
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Authors:
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Wayne L Miller; Karen A Hartman; Mary F Burritt; Daniel D Borgeson; John C Burnett; Allan S Jaffe |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2004-12-22 |
Journal Detail:
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Title: Clinical chemistry Volume: 51 ISSN: 0009-9147 ISO Abbreviation: Clin. Chem. Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-03-01 Completed Date: 2005-04-11 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9421549 Medline TA: Clin Chem Country: United States |
Other Details:
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Languages: eng Pagination: 569-77 Citation Subset: IM |
Affiliation:
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Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA. miller.wayne@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biological Markers / blood Chemiluminescent Measurements Chronic Disease Cohort Studies Drug Monitoring / methods Female Heart Failure / drug therapy* Humans Immunoassay Infusions, Intravenous Male Natriuretic Peptide, Brain / administration & dosage, blood*, therapeutic use* Nerve Tissue Proteins / blood* Peptide Fragments / blood* Protein Precursors / blood* Recombinant Proteins / administration & dosage, therapeutic use Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Nerve Tissue Proteins; 0/Peptide Fragments; 0/Protein Precursors; 0/Recombinant Proteins; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain |
| Comments/Corrections | |
Erratum In:
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Clin Chem. 2005 Apr;51(4):798 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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