Document Detail


Effects of B-type natriuretic peptide (nesiritide) on coronary epicardial arteries, systemic vasculature and microvessels.
MedLine Citation:
PMID:  18252972     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Nesiritide is recombinant human B-type natriuretic peptide, used in the treatment of decompensated heart failure. Ischemic heart disease remains the major underlying cause for congestive heart failure, however, the effects of intravenous and intracoronary nesiritide on coronary circulation have not been adequately studied. METHODS: Fourteen Yorkshire pigs were used to systematically evaluate the effects of intravenous and intracoronary nesiritide on microvascular function, coronary blood flow, and epicardial and microvascular reactivity using in vivo hemodynamic parameters, Doppler flow assessment (average peak velocity, APV) and intravascular ultrasound (cross-sectional area, CSA), and in vitro microvascular function. RESULTS: The clinically used dose of nesiritide caused a small (not statistically significant) decrease in blood pressure at 10 minutes (p = 0.6411); blood pressure returned to baseline at 30 minutes and did not affect coronary flow or diameter. Intracoronary nesiritide (100 mcg) resulted in a slight increase (trend) in coronary flow (increase from 15.8 to 19 cm/s; p = 0.6), but no change in CSA. Nesiritide caused significant microvascular relaxation in vitro (p = 0.009), attenuated by pretreatment with L-NAME indicating that vasodilation is partially nitric oxide-dependent. CONCLUSIONS: Intravenous and intracoronary nesiritide do not result in adverse effects on the normal coronary circulation in pigs. In contrast it has profound effects on microvessels with potentially beneficial effects on the myocardial perfusion at the tissue level. Further studies are needed to assess its effects on diseased coronary circulation and its safety in patients with ischemic heart disease.
Authors:
Gui Fu Wu; Joanna J Wykrzykowska; Jamal S Rana; Duane S Pinto; C Michael Gibson; Jian Li; Frank W Sellke; Roger J Laham
Publication Detail:
Type:  In Vitro; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  20     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-06     Completed Date:  2008-03-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  76-80     Citation Subset:  IM    
Affiliation:
Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. rlaham@bidmc.harvard.edu.
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Flow Velocity / drug effects
Coronary Circulation / drug effects*
Coronary Vessels / drug effects*,  ultrasonography
Echocardiography, Doppler
Infusions, Intravenous
Microcirculation / drug effects
Natriuretic Agents / pharmacology*
Natriuretic Peptide, Brain / pharmacology*
Regional Blood Flow / drug effects*
Swine
Grant Support
ID/Acronym/Agency:
HL 46716/HL/NHLBI NIH HHS; HL 63609/HL/NHLBI NIH HHS; M01-RR-1032/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Natriuretic Agents; 114471-18-0/Natriuretic Peptide, Brain

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