Document Detail

Sodium nitroprusside for advanced low-output heart failure.
MedLine Citation:
PMID:  18617068     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study was designed to examine the safety and efficacy of sodium nitroprusside (SNP) for patients with acute decompensated heart failure (ADHF) and low-output states. BACKGROUND: Inotropic therapy has been predominantly used in the management of patients with ADHF presenting with low cardiac output. METHODS: We reviewed all consecutive patients with ADHF admitted between 2000 and 2005 with a cardiac index < or =2 l/min/m(2) for intensive medical therapy including vasoactive drugs. Administration of SNP was chosen by the attending clinician, nonrandomized, and titrated to a target mean arterial pressure of 65 to 70 mm Hg. RESULTS: Compared with control patients (n = 97), cases treated with SNP (n = 78) had significantly higher mean central venous pressure (15 vs. 13 mm Hg; p = 0.001), pulmonary capillary wedge pressure (29 vs. 24 mm Hg; p = 0.001), but similar demographics, medications, and renal function at baseline. Use of SNP was not associated with higher rates of inotropic support or worsening renal function during hospitalization. Patients treated with SNP achieved greater improvement in hemodynamic measurements during hospitalization, had higher rates of oral vasodilator prescription at discharge, and had lower rates of all-cause mortality (29% vs. 44%; odds ratio: 0.48; p = 0.005; 95% confidence interval: 0.29 to 0.80) without increase in rehospitalization rates (58% vs. 56%; p = NS). CONCLUSIONS: In patients with advanced, low-output heart failure, vasodilator therapy used in conjunction with optimal current medical therapy during hospitalization might be associated with favorable long-term clinical outcomes irrespective of inotropic support or renal dysfunction and remains an excellent therapeutic choice in hospitalized ADHF patients.
Wilfried Mullens; Zuheir Abrahams; Gary S Francis; Hadi N Skouri; Randall C Starling; James B Young; David O Taylor; W H Wilson Tang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  52     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-11     Completed Date:  2008-09-04     Revised Date:  2009-03-23    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-7     Citation Subset:  AIM; IM    
Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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MeSH Terms
Biological Markers / blood
Cardiotonic Agents / therapeutic use*
Case-Control Studies
Drug Administration Schedule
Heart Failure / blood,  drug therapy*,  physiopathology
Hemodynamics / drug effects
Middle Aged
Nitroprusside / administration & dosage,  adverse effects,  therapeutic use*
Retrospective Studies
Risk Factors
Stroke Volume / drug effects*
Vasodilator Agents / administration & dosage,  adverse effects,  therapeutic use*
Reg. No./Substance:
0/Biological Markers; 0/Cardiotonic Agents; 0/Vasodilator Agents; 15078-28-1/Nitroprusside
Comment In:
J Am Coll Cardiol. 2008 Jul 15;52(3):208-10   [PMID:  18617069 ]
J Am Coll Cardiol. 2009 Mar 10;53(10):898; discussion 898-99   [PMID:  19264253 ]

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