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Predictors of responders for low-dose carperitide monotherapy in patients with acute heart failure

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Abstract

Human atrial natriuretic peptide, known as carperitide, is approved for early relief of dyspnea in patients with acute heart failure (AHF). However, the diuretic effect of carperitide is sometimes insufficient for controlling volume overload. We investigated predictors for the carperitide response in patients with AHF. Forty-seven patients (age: 74 ± 10 years; left ventricular ejection fraction: 42.0% ± 15.9%) with AHF were enrolled and treated with carperitide monotherapy at a dose of 0.0125 μg/kg/min. Patients without sufficient diuresis (< 60 ml/h) or improvement of symptoms by 4 h after carperitide administration, despite increasing to twice the dose of carperitide and adding another agent, were defined as non-responders. Twenty-four (51%) patients were defined as responders and treated with low-dose carperitide monotherapy on the first day. Multiple logistic regression analysis showed that the response to carperitide monotherapy was independently predicted by serum creatinine levels and systolic blood pressure (SBP) on admission. The area under the receiver-operating characteristic curve for predicting the response to carperitide by SBP was 0.808 (95% confidence interval [0.686–0.930], sensitivity: 83.3%, specificity: 65.2%, cutoff value: 135 mmHg). Four (8.5%) patients developed asymptomatic transient hypotension. Worsening renal function occurred within 3 days of admission in three (6.4%) patients who received low-dose carperitide therapy. SBP and serum creatinine levels on admission might be useful for predicting the diuretic response to low-dose carperitide monotherapy in patients with AHF. Initial use of low-dose carperitide therapy does not have adverse effects on renal function.

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Acknowledgements

The authors thank the staff of the Intensive Care Unit at the Fraternity Memorial Hospital for their help.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Masataka Kamiya & Wataru Shimizu

  2. Department of Internal Medicine and Cardiology, Nippon Medical School, Musashi-Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki-shi, 211-8533, Kanagawa, Japan

    Naoki Sato

  3. Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan

    Junya Matsuda, Ayaka Nozaki, Mai Akiya, Taisuke Sato, Hirotake Okazaki & Yasuhiro Takahashi

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  1. Masataka Kamiya
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Kamiya, M., Sato, N., Matsuda, J. et al. Predictors of responders for low-dose carperitide monotherapy in patients with acute heart failure. Heart Vessels 35, 59–68 (2020). https://doi.org/10.1007/s00380-019-01450-w

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