The Management of Decompensated Heart Failure Resulting in Hospitalization: Proceedings from an Expert Meeting To Review Current Concepts and To Define Future DirectionsB-Type natriuretic peptide: From bench to bedside☆,☆☆,★
Section snippets
The natriuretic peptide family
Currently, at least 4 members of the structurally similar but genetically distinct natriuretic peptide hormone family are known: atrial natriuretic peptide (ANP), BNP, C-type natriuretic peptide (CNP), and dendroaspis natriuretic peptide (DNP).6, 7, 8, 9, 10 Unlike ANP, which is secreted primarily by cardiac atria in response to atrial stretch, BNP is secreted by both atrial and ventricular myocardial cells. However, in the setting of HF, the predominant source of BNP production is ventricular
Nesiritide
hBNP has been duplicated as nesiritide, a recombinant form of hBNP that is structurally identical to the endogenously produced hormone. The development of nesiritide for the treatment of HF has involved 10 clinical trials to date, with >1000 patients participating. In the early phase II trials, nesiritide was studied as a short-term monotherapy. The clinical status of patients in these studies allowed their temporary withdrawal from other therapies such as diuretics, digoxin, and ACE
Conclusions
Nesiritide is an effective and safe agent for improving hemodynamic profiles and symptoms of disease in patients with ADHF. Its diuretic and natriuretic effects are not associated with neurohormonal activation; in fact, during nesiritide therapy, endothelin-1, norepinephrine, and RAAS activation are reduced. The population of patients with ADHF varies widely. Preserved systolic function is frequently seen in these individuals but they often have ischemic heart disease, renal insufficiency, and
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Cited by (37)
Cardiovascular Outcomes Assessment of the MitraClip in Patients with Heart Failure and Secondary Mitral Regurgitation: Design and rationale of the COAPT trial
2018, American Heart JournalCitation Excerpt :In addition to undergoing the MitraClip procedure, subjects randomized to the Device group will continue to be treated with GDMT consistent with the subject’s condition during follow-up. Eligible subjects have HF due to ischemic or idiopathic dilated cardiomyopathy, with LV ejection fraction 20%-50%; have moderate-to-severe (3+) or severe (4+) SMR18,19 as confirmed by the study ECL prior to enrollment; are symptomatic (NYHA class II-IVa) despite maximally tolerated GDMT including CRT and revascularization as appropriate; have had an HF hospitalization within the prior 12 months or have an elevated level of brain natriuretic peptide (BNP) or N-terminal pro b-type natriuretic peptide (NT-proBNP) (which has been shown to correlate with future HF hospitalizations20-22); and have been determined by the site’s local heart team as not being appropriate for MV surgery. A complete list of the COAPT trial inclusion and exclusion criteria appears in Table II.
Obesity and the Obesity Paradox in Heart Failure
2015, Canadian Journal of CardiologyCitation Excerpt :Of note, obesity is significantly more prevalent in patients with HF with preserved ejection fraction compared with those with reduced ejection fraction.30 The role of natriuretic peptides in the clinical expression of chronic HF has been established.31 Studies have shown that natriuretic peptide levels are reduced in the obese state, partly related to altered clearance receptors and peptide degradation.32,33
Nesiritide Administration in Patients With Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery<sup>*</sup>*Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.
2007, Journal of the American College of CardiologyNesiritide as Bridge to Multi-Organ Transplantation: A Case Report
2007, Transplantation ProceedingsBeyond Diuretics: Management of Volume Overload in Acute Heart Failure Syndromes
2006, American Journal of MedicineCitation Excerpt :Currently identified natriuretic peptides include atrial natriuretic peptide (ANP), human B-type natriuretic peptide (hBNP), C-type natriuretic peptide, dendroaspis natriuretic peptide,61 and urodilatin. ANP is released by cardiac atria in response to atrial stress, whereas hBNP is released by both atrial and ventricular myocardial cells in response to wall stress.61 Levels of hBNP in particular are elevated in patients with HF in response to pressure and volume overload, and it has been theorized that hBNP acts as a counterregulatory physiologic response to the RAAS activation that occurs in HF62; hBNP also enhances natriuresis and diuresis.63,64
Chronic digoxin toxicity and significantly elevated BNP levels in the presence of mild heart failure
2005, American Journal of Emergency Medicine
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Reprint requests: Kirkwood F. Adams, Jr, MD, Division of Cardiology, University of North Carolina at Chapel Hill, CB# 7075, Burnett-Womack Building, Chapel Hill, NC 27599-7075.
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E-mail: [email protected]
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