Pediatric Cardiology

, Volume 30, Issue 1, pp 26–34 | Cite as

Nesiritide Improves Hemodynamics in Children with Dilated Cardiomyopathy: A Pilot Study

  • Sarina K. Behera
  • Jennifer C. Zuccaro
  • Glenn T. Wetzel
  • Juan C. Alejos
Original Article


Background This study aimed to obtain hemodynamic measurements of nesiritide in children with dilated cardiomyopathy. Methods A prospective, randomized, double-blinded, placebo-controlled pilot study was conducted in the pediatric intensive care unit at the University of California, Los Angeles. All subjects younger than 21 years admitted to the pediatric intensive care unit with a diagnosis of dilated cardiomyopathy and submitted to cardiac catheterization were randomized to receive either nesiritide or placebo. Right heart catheterization with Swan-Ganz catheter placement was performed. Nesiritide was infused over 24 h. Hemodynamic data were obtained before, during, and after the 24-h nesiritide infusion. The measures obtained included pulmonary capillary wedge pressure (PCWP), central venous pressure, mean pulmonary arterial pressure (MPAP), systolic arterial blood pressure (SBP), cardiac index, and systemic vascular resistance. Results The study included 20 children: 9 randomized to nesiritide and 11 to placebo. At 24 h, the mean decreases in PCWP, MPAP, and SBP were significantly greater for nesiritide than for placebo: PCWP (–5.3 vs. 1.2 mmHg; p = 0.02), MPAP (–8.0 vs. 0.4 mmHg; p = 0.006), SBP (–7.9 vs. 2.6 mmHg; p = 0.04). Conclusions Nesiritide significantly decreases PCWP, MPAP, and SBP in children with dilated cardiomyopathy.


Nesiritide Dilated cardiomyopathy Heart failure 


  1. 1.
    Publication Committee for the VMAC Investigators (2002) Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: A randomized controlled trial. JAMA 287:1531–1540Google Scholar
  2. 2.
    Abraham WT, Lowes BD, Ferguson DA et al (1998) Systemic hemodynamic, neurohormonal, and renal effects of a steady-state infusion of human brain natriuretic peptide in patients with hemodynamically decompensated heart failure. J Card Fail 4:37–44PubMedCrossRefGoogle Scholar
  3. 3.
    Akabane S, Matsushima Y, Matsuo H et al (1991) Effects of brain natriuretic peptide on renin secretion in normal and hypertonic saline-infused kidney. Eur J Pharmacol 198:143–148PubMedCrossRefGoogle Scholar
  4. 4.
    Boucek MM, Faro A, Novick RJ et al (2001) The registry of the international society for heart and lung transplantation: fourth official pediatric report-2000. J Heart Lung Transplant 20:39–52PubMedCrossRefGoogle Scholar
  5. 5.
    Burger AJ, Elkayam U, Neibaur MT et al (2001) Comparison of the occurrence of ventricular arrhythmias in patients with acutely decompensated congestive heart failure receiving dobutamine versus nesiritide therapy. Am J Cardiol 88:35–39PubMedCrossRefGoogle Scholar
  6. 6.
    Colucci WS, Elkayam U, Horton DP et al (2000) Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group. N Engl J Med 343:246–253PubMedCrossRefGoogle Scholar
  7. 7.
    Feingold B, Law YM (2004) Nesiritide use in pediatric patients with congestive heart failure. J Heart Lung Transplant 23:1455–1459PubMedCrossRefGoogle Scholar
  8. 8.
    Hobbs RE, Miller LW, Bott-Silverman C et al (1996) Hemodynamic effects of a single intravenous injection of synthetic human brain natriuretic peptide in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 78:896–901PubMedCrossRefGoogle Scholar
  9. 9.
    Holmes SJ, Espiner EA, Richards AM et al (1993) Renal, endocrine, and hemodynamic effects of human brain natriuretic peptide in normal man. J Clin Endocrinol Metab 76:91–96PubMedCrossRefGoogle Scholar
  10. 10.
    Jefferies JL, Denfield SW, Price JF et al (2006) A prospective evaluation of nesiritide in the treatment of pediatric heart failure. Pediatr Cardiol 27:402–407PubMedCrossRefGoogle Scholar
  11. 11.
    Keating GM, Goa KL (2003) Nesiritide: a review of its use in acute decompensated heart failure. Drugs 63:47–70PubMedCrossRefGoogle Scholar
  12. 12.
    Koller KJ, Goeddel DV (1992) Molecular biology of the natriuretic peptides and their receptors. Circulation 86:1081–1088PubMedGoogle Scholar
  13. 13.
    Lipshultz SE (2000) Ventricular dysfunction clinical research in infants, children, and adolescents. Prog Pediatr Cardiol 12:1–28PubMedCrossRefGoogle Scholar
  14. 14.
    Lipshultz SE, Sleeper LA, Towbin JA et al (2003) The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 348:1647–1655PubMedCrossRefGoogle Scholar
  15. 15.
    Mahle WT, Cuadrado AR, Kirshbom PM et al (2005) Nesiritide in infants and children with congestive heart failure. Pediatr Crit Care Med 6:543–546PubMedCrossRefGoogle Scholar
  16. 16.
    Marcus LS, Hart D, Packer M et al (1996) Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure: a double-blind, placebo-controlled, randomized crossover trial. Circulation 94:3184–3189PubMedGoogle Scholar
  17. 17.
    Marshall J, Berkenbosch JW, Russo P, Tobias JD (2004) Preliminary experience with nesiritide in the pediatric population. J Intensive Care Med 19:164–170PubMedCrossRefGoogle Scholar
  18. 18.
    Mentzer RM Jr, Oz MC, Sladen RN et al (2007) Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the NAPA Trial. J Am Coll Cardiol 49:716–726PubMedCrossRefGoogle Scholar
  19. 19.
    Mills RM, LeJemtel TH, Horton DP et al (1999) Sustained hemodynamic effects of an infusion of nesiritide (human B-type natriuretic peptide) in heart failure: a randomized, double-blind, placebo-controlled clinical trial. Natrecor Study Group. J Am Coll Cardiol 34:155–162PubMedCrossRefGoogle Scholar
  20. 20.
    Moffett BS, Jefferies JL, Price JF et al (2006) Administration of a large nesiritide bolus dose in a pediatric patient: case report and review of nesiritide use in pediatrics. Pharmacotherapy 26:277–280PubMedCrossRefGoogle Scholar
  21. 21.
    Rosenthal D, Chrisant MR, Edens E et al (2004) International society for heart and lung transplantation: practice guidelines for management of heart failure in children. J Heart Lung Transplant 23:1313–1333PubMedCrossRefGoogle Scholar
  22. 22.
    Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K (2005) Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA 293:1900–1905PubMedCrossRefGoogle Scholar
  23. 23.
    Sackner-Bernstein JD, Skopicki HA, Aaronson KD (2005) Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation 111:1487–1491PubMedCrossRefGoogle Scholar
  24. 24.
    Schamberger MS (2004) Is there a use for nesiritide in pediatric patients? J Intensive Care Med 19:171–173PubMedCrossRefGoogle Scholar
  25. 25.
    Simsic JM, Reddy VS, Kanter KR et al (2004) Use of nesiritide (human B-type natriuretic peptide) in infants following cardiac surgery. Pediatr Cardiol 25:668–670PubMedCrossRefGoogle Scholar
  26. 26.
    Simsic JM, Scheurer M, Tobias JD et al (2006) Perioperative effects and safety of nesiritide following cardiac surgery in children. J Intensive Care Med 21:22–26PubMedCrossRefGoogle Scholar
  27. 27.
    Smith T, Rosen DA, Russo P et al (2005) Nesiritide during extracorporeal membrane oxygenation. Paediatr Anaesth 15:152–157PubMedCrossRefGoogle Scholar
  28. 28.
    Witteles RM, Kao D, Christopherson D et al (2007) Impact of nesiritide on renal function in patients with acute decompensated heart failure and preexisting renal dysfunction: a randomized, double-blind, placebo-controlled clinical trial. J Am Coll Cardiol 50:1835–1840PubMedCrossRefGoogle Scholar
  29. 29.
    Yamamoto K, Burnett JC Jr, Redfield MM (1997) Effect of endogenous natriuretic peptide system on ventricular and coronary function in failing heart. Am J Physiol 273:H2406–H2414PubMedGoogle Scholar
  30. 30.
    Yancy CW, Krum H, Silver M et al (2007) Chronic serial infusion of nesiritide is not associated with worsening renal function in chronic decompensated heart failure patients with renal insufficiency: an analysis from the FUSION-II trial (abstract). J Card Fail 13:S136CrossRefGoogle Scholar
  31. 31.
    Yasue H, Yoshimura M (1996) Natriuretic peptides in the treatment of heart failure. J Card Fail 2:S277–S285PubMedCrossRefGoogle Scholar
  32. 32.
    Yasue H, Yoshimura M, Sumida H et al (1994) Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 90:195–203PubMedGoogle Scholar
  33. 33.
    Yoshimura M, Yasue H, Morita E et al (1991) Hemodynamic, renal, and hormonal responses to brain natriuretic peptide infusion in patients with congestive heart failure. Circulation 84:1581–1588PubMedGoogle Scholar
  34. 34.
    Zineh I, Schofield RS, Johnson JA (2003) The evolving role of nesiritide in advanced or decompensated heart failure. Pharmacotherapy 23:1266–1280PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sarina K. Behera
    • 1
  • Jennifer C. Zuccaro
    • 1
  • Glenn T. Wetzel
    • 2
  • Juan C. Alejos
    • 1
    • 3
  1. 1.Department of PediatricsUniversity of CaliforniaLos AngelesUSA
  2. 2.Department of PediatricsUniversity of Tennessee Health Science CenterMemphisUSA
  3. 3.Department of Pediatric CardiologyUCLA Medical CenterLos AngelesUSA

Personalised recommendations