Acute effects of intravenous nesiritide on cardiac contractility in heart failure

Sanjiv J. Shah, Andrew D. Michaels

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Although nesiritide is a potent vasodilator, studies using myocytes and isolated muscle strips have shown that recombinant B-type natriuretic peptide (BNP; nesiritide) decreases contractility. We sought to determine whether nesiritide decreases contractility in heart failure patients. Methods and Results: Twenty-five heart failure patients underwent left heart catheterization (using a pressure-volume conductance catheter) and echocardiography at baseline and after a 2 mcg/kg bolus and 30-minute nesiritide infusion (0.01 mcg·kg·min). From invasive and noninvasive measurements, left ventricular (LV) systolic function indices were calculated, including ejection fraction, end-systolic elastance (Ees; single-beat invasive and noninvasive methods) and preload-recruitable stroke work (PRSW; noninvasive, single-beat method). The mean age was 60 ± 11 years, 48% were male, 56% had coronary disease, and 64% had hypertension. Although nesiritide did not change LV ejection fraction, it did decrease contractility on pressure-volume analysis. Noninvasive Ees decreased from 2.6 ± 1.6 to 2.0 ± 1.4 mm Hg/mL (P = .02). For those with reduced ejection fraction, Ees decreased by invasive (P = .006) and noninvasive (P = .02) methods. PRSW decreased from 76 ± 37 to 62 ± 28 g/cm2 (P = .003). On tissue Doppler imaging, nesiritide reduced the systolic annular tissue velocity of the mitral annulus from 8.0 ± 1.9 to 6.9 ± 1.3 cm/s (P = .04). Conclusions: Nesiritide infusion acutely decreases derived measures of contractility and systolic function in patients with chronic heart failure.

Original languageEnglish (US)
Pages (from-to)720-727
Number of pages8
JournalJournal of Cardiac Failure
Volume16
Issue number9
DOIs
StatePublished - Sep 2010

Keywords

  • Nesiritide
  • contractility
  • heart failure
  • natriuretic peptide
  • systole

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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