| Sodium nitroprusside for advanced low-output heart failure. | |
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MedLine Citation:
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PMID: 18617068 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2008-07-11 Completed Date: 2008-09-04 Revised Date: 2009-03-23 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 200-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio 44195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Biological Markers
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blood Cardiotonic Agents / therapeutic use* Case-Control Studies Drug Administration Schedule Female Heart Failure / blood, drug therapy*, physiopathology Hemodynamics / drug effects Hospitalization Humans Male 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* |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Cardiotonic Agents; 0/Vasodilator Agents; 15078-28-1/Nitroprusside |
| Comments/Corrections | |
Comment In:
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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 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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