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Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes

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Abstract

While recent guidelines for the treatment of acute heart failure syndromes (AHFS) recommend pharmacotherapy with vasodilators in patients without excessively low blood pressure (BP), few reports have compared the relative efficiency of vasodilators on hemodynamics in AHFS patients. The present study aimed to assess the differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with AHFS. Thirty-eight consecutive patients were assigned to receive 48-h continuous infusion of carperitide (n = 19; 0.0125–0.05 μg/kg/min) or nicorandil (n = 19; 0.05–0.2 mg/kg/h). Hemodynamic parameters were estimated at baseline, and 2, 24, and 48 h after drug administration using echocardiography. After 48 h of infusion, systolic BP was significantly more decreased in the carperitide group compared with that in the nicorandil group (22.1 ± 20.0 % vs 5.3 ± 10.4 %, P = 0.003). While both carperitide and nicorandil significantly improved hemodynamic parameters, improvement of estimated pulmonary capillary wedge pressure was greater in the carperitide group (38.2 ± 14.5 % vs 26.5 ± 18.3 %, P = 0.036), and improvement of estimated cardiac output was superior in the nicorandil group (52.1 ± 33.5 % vs 11.4 ± 36.9 %, P = 0.001). Urine output for 48 h was greater in the carperitide group, but not to a statistically significant degree (4203 ± 1542 vs 3627 ± 1074 ml, P = 0.189). Carperitide and nicorandil were differentially effective in improving hemodynamics in AHFS patients. This knowledge may enable physicians in emergency wards to treat and manage patients with AHFS more effectively and safely.

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References

  1. Gheorghiade M, Pang PS (2009) Acute heart failure syndromes. J Am Coll Cardiol 53:557–573

    Article  PubMed  Google Scholar 

  2. Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L (2005) Acute heart failure syndromes: current state and framework for future research. Circulation 112:3958–3968

    Article  PubMed  Google Scholar 

  3. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442

    Article  PubMed  CAS  Google Scholar 

  4. Lee CY, Burnett JC Jr (2007) Natriuretic peptides and therapeutic applications. Heart Fail Rev 12:131–142

    Article  PubMed  CAS  Google Scholar 

  5. Saito Y, Nakao K, Nishimura K, Sugawara A, Okumura K, Obata K, Sonoda R, Ban T, Yasue H, Imura H (1987) Clinical application of atrial natriuretic polypeptide in patients with congestive heart failure: beneficial effects on left ventricular function. Circulation 76:115–124

    Article  PubMed  CAS  Google Scholar 

  6. Zhao Q, Wu TG, Lin Y, Li B, Luo JY, Wang LX (2010) Low-dose nesiritide improves renal function in heart failure patients following acute myocardial infarction. Heart Vessels 25:97–103

    Article  PubMed  Google Scholar 

  7. Nomura F, Kurobe N, Mori Y, Hikita A, Kawai M, Suwa M, Okutani Y (2008) Multicenter prospective investigation on efficacy and safety of carperitide as a first-line drug for acute heart failure syndrome with preserved blood pressure: COMPASS: carperitide effects observed through monitoring dyspnea in acute decompensated heart failure study. Circ J 72:1777–1786

    Article  PubMed  CAS  Google Scholar 

  8. Suwa M, Seino Y, Nomachi Y, Matsuki S, Funahashi K (2005) Multicenter prospective investigation on efficacy and safety of carperitide for acute heart failure in the ‘real world’ of therapy. Circ J 69:283–290

    Article  PubMed  Google Scholar 

  9. Taira N (1989) Nicorandil as a hybrid between nitrates and potassium channel activators. Am J Cardiol 63:18J–24J

    Article  PubMed  CAS  Google Scholar 

  10. Giles TD, Pina IL, Quiroz AC, Roffidal L, Zaleski R, Porter RS, Karalis DG, Mohrland JS, Wolf DL, Hearron AE (1992) Hemodynamic and neurohumoral responses to intravenous nicorandil in congestive heart failure in humans. J Cardiovasc Pharmacol 20:572–578

    Article  PubMed  CAS  Google Scholar 

  11. Minami Y, Nagashima M, Kajimoto K, Shiga T, Hagiwara N (2009) Acute efficacy and safety of intravenous administration of nicorandil in patients with acute heart failure syndromes: usefulness of noninvasive echocardiographic hemodynamic evaluation. J Cardiovasc Pharmacol 54:335–340

    Article  PubMed  CAS  Google Scholar 

  12. Nieminen MS, Harjola VP (2005) Definition and epidemiology of acute heart failure syndromes. Am J Cardiol 96:5G–10G

    Article  PubMed  Google Scholar 

  13. Koide K, Yoshikawa T, Nagatomo Y, Kohsaka S, Anzai T, Meguro T, Ogawa S (2010) Elevated troponin T on discharge predicts poor outcome of decompensated heart failure. Heart Vessels 25:217–222

    Article  PubMed  Google Scholar 

  14. Hata N, Seino Y, Tsutamoto T, Hiramitsu S, Kaneko N, Yoshikawa T, Yokoyama H, Tanaka K, Mizuno K, Nejima J, Kinoshita M (2008) Effects of carperitide on the long-term prognosis of patients with acute decompensated chronic heart failure: the PROTECT multicenter randomized controlled study. Circ J 72:1787–1793

    Article  PubMed  CAS  Google Scholar 

  15. Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66:493–496

    Article  PubMed  CAS  Google Scholar 

  16. Lee KS, Abbas AE, Khandheria BK, Lester SJ (2007) Echocardiographic assessment of right heart hemodynamic parameters. J Am Soc Echocardiogr 20:773–782

    Article  PubMed  Google Scholar 

  17. Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70:657–662

    Article  PubMed  CAS  Google Scholar 

  18. Lee RT, Lord CP, Plappert T, Sutton MS (1989) Prospective Doppler echocardiographic evaluation of pulmonary artery diastolic pressure in the medical intensive care unit. Am J Cardiol 64:1366–1370

    Article  PubMed  CAS  Google Scholar 

  19. Ihlen H, Amlie JP, Dale J, Forfang K, Nitter-Hauge S, Otterstad JE, Simonsen S, Myhre E (1984) Determination of cardiac output by Doppler echocardiography. Br Heart J 51:54–60

    Article  PubMed  CAS  Google Scholar 

  20. Stein JH, Neumann A, Preston LM, Costanzo MR, Parrillo JE, Johnson MR, Marcus RH (1997) Echocardiography for hemodynamic assessment of patients with advanced heart failure and potential heart transplant recipients. J Am Coll Cardiol 30:1765–1772

    Article  PubMed  CAS  Google Scholar 

  21. Shirakabe A, Hata N, Yokoyama S, Shinada T, Kobayashi N, Asai K, Mizuno K (2010) Efficacy and safety of nicorandil therapy in patients with acute heart failure. J Cardiol 56:339–347

    Article  PubMed  Google Scholar 

  22. Tanaka K, Kato K, Takano T, Katagiri T, Asanoi H, Nejima J, Nakashima M, Kamijo T, Sakanashi M (2010) Acute effects of intravenous nicorandil on hemodynamics in patients hospitalized with acute decompensated heart failure. J Cardiol 56:291–299

    Article  PubMed  Google Scholar 

  23. Kobatake R, Sato T, Fujiwara Y, Sunami H, Yoshioka R, Ikeda T, Saito H, Ujihira T (2011) Comparison of the effects of nitroprusside versus nicorandil on the slow/no-reflow phenomenon during coronary interventions for acute myocardial infarction. Heart Vessels 26:379–384

    Article  PubMed  Google Scholar 

  24. Kanagawa K, Matsuo H (1984) Purification and complete amino acid sequence of alpha-human atrial natriuretic polypeptide (alpha-hANP). Biochem Biophys Res Commun 118:131–139

    Article  Google Scholar 

  25. Serizawa T, Hirata Y, Kohmoto O, Iizuka M, Matsuoka H, Sato H, Takahashi T, Mochizuki T, Ishii M, Sugimoto T (1988) Acute hemodynamic effects of alpha human atrial natriuretic polypeptide in patients with congestive heart failure. Jpn Heart J 29:143–149

    Article  PubMed  CAS  Google Scholar 

  26. Hayashi M, Tsutamoto T, Wada A, Maeda K, Mabuchi N, Tsutsui T, Horie H, Ohnishi M, Kinoshita M (2001) Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction. J Am Coll Cardiol 37:1820–1826

    Article  PubMed  CAS  Google Scholar 

  27. Kosuge M, Miyajima E, Kimura K, Ishikawa T, Tochikubo O, Ishii M (1998) Comparison of atrial natriuretic peptide versus nitroglycerin for reducing blood pressure in acute myocardial infarction. Am J Cardiol 81:781–784

    Article  PubMed  CAS  Google Scholar 

  28. Filippatos G, Zannad F (2007) An introduction to acute heart failure syndromes: definition and classification. Heart Fail Rev 12:87–90

    Article  PubMed  Google Scholar 

  29. Gheorghiade M, De Luca L, Fonarow GC, Filippatos G, Metra M, Francis GS (2005) Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol 96:11G–17G

    Article  PubMed  Google Scholar 

  30. Kajimoto K, Sashida Y, Minami Y, Yumino D, Kawarai H, Kasanuki H (2009) Systolic blood pressure at admission as a predictor of the response to initial carperitide therapy in patients hospitalized for acute decompensated heart failure with left ventricular systolic dysfunction. Cardiovasc Drugs Ther 23:481–488

    Article  PubMed  CAS  Google Scholar 

  31. Kajimoto K, Shimamura K (2011) Acute efficacy of combined therapy of carperitide and nicorandil for acute decompensated heart failure with left ventricular systolic dysfunction. Int J Cardiol 149:e55–e58

    Article  PubMed  Google Scholar 

  32. Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW (2005) Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 294:1625–1633

    Article  PubMed  Google Scholar 

  33. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM, Sopko G, Califf RM (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294:1664–1670

    Article  PubMed  CAS  Google Scholar 

  34. Thohan V (2004) Prognostic implications of echocardiography in advanced heart failure. Curr Opin Cardiol 19:238–249

    Article  PubMed  Google Scholar 

  35. Weeks SG, Shapiro M, Foster E, Michaels AD (2008) Echocardiographic predictors of change in left ventricular diastolic pressure in heart failure patients receiving nesiritide. Echocardiography 25:849–855

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Erisa Watanabe, Yuri Ozaki, and Keiko Hayashi for excellent clinical assistance, and Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan) for expert statistical assistance.

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Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Hidetoshi Hattori, Yuichiro Minami, Masayuki Mizuno, Dai Yumino, Hiromi Hoshi, Hiroyuki Arashi, Toshiaki Nuki, Yukiko Sashida, Michiaki Higashitani, Naoki Serizawa, Norihiro Yamada, Junichi Yamaguchi, Fumiaki Mori, Tsuyoshi Shiga & Nobuhisa Hagiwara

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  1. Hidetoshi Hattori
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  2. Yuichiro Minami
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Correspondence to Yuichiro Minami.

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Hattori, H., Minami, Y., Mizuno, M. et al. Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes. Heart Vessels 28, 345–351 (2013). https://doi.org/10.1007/s00380-012-0252-7

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  • DOI: https://doi.org/10.1007/s00380-012-0252-7

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