Natriuretic Peptide Infusion Helps Advanced Heart Failure

	July 01, 1999 - Infusion of human b-type natriuretic
peptide (nesiritide, trade named Natrecor) produces immediate
and sustained benefits in patients with heart failure,
according to a report in the July issue of the Journal of the
American College of Cardiology.
	In a study led by Dr. Roger Mills of the Cleveland
Clinic, 103 patients with class 2, 3 or 4 heart failure 
received one of three intravenous dosages of nesiritide 
(0.015, 0.03, 0.06 microgram/kg/min) or a placebo, 
continuously over 24 hours.
	Pulmonary arterial wedge pressure, right atrial
pressure, and systemic vascular resistance were significantly
decreased for all the nesiritide patients (that's good).
Cardiac index and stroke volume index were significantly
increased (that's good). Hemodynamic improvement was seen
one hour after infusion began, and continued for the 
duration of the infusion. No rebound effect was seen when
infusion was stopped.
	Nesiritide did not increase urine output compared
with the placebo group and no significant changes in heart
rate were observed during the infusion period. Unacceptable
decreases in pulmonary arterial wedge pressure required 
lowering nesiritide dose in some patients. Dose-dependent
low blood pressure and nausea were also reported.
	Nesiritide is for treating patients with acutely
decompensated heart failure, such as the patients who
currently take IV dobutamine, Inocor or Primacor. It is
for in-hospital use for CHFers who are "in" heart failure
despite oral meds. Approval of nesiritide by the FDA is
pending.

J Am Coll Cardiol 1999,34:155-162