Effects of intravenous nesiritide on human coronary vasomotor regulation and myocardial oxygen uptake
Effects of intravenous nesiritide on human coronary vasomotor regulation and myocardial oxygen uptake
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DOI：
10.1161/01.cir.0000070547.88378.ea
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发表时间：
2003-06-03
期刊：
影响因子：
37.8
通讯作者：
Chatterjee, K
中科院分区：
文献类型：
--
作者：
Michaels, AD;Klein, A;Chatterjee, K
背景-奈西立肽，重组人B型利钠肽，已被证明是治疗失代偿性心力衰竭的有效药物。静脉注射奈西立肽对人类冠状动脉血管的影响还没有研究。方法和结果-10名患者接受了右心和左心导管。使用定量冠状动脉造影术(QCA)和冠脉内多普勒导丝测定基础冠脉血流量。使用冠状静脉窦导管测量心肌摄氧量。然后，患者接受奈西立肽静脉滴注(2杯/公斤，然后每分钟0.01杯/公斤)，持续30分钟。右心房压下降52%(P=0.012)，肺动脉平均压下降19%(P=0.03)，肺毛细血管嵌顿压下降46%(P=0.002)，平均动脉压下降11%(P=0.007)。QCA显示冠状动脉内径从基线的2.6+/-0.8 mm增加到30min的3.0+/-0.8 mm(P=0.007)。冠脉平均峰值速度从基线的20.8+/-6.4%增加到5min的23.8+/-7.2 cm/S(P=0.015)，然后恢复到基线水平。冠脉血流量在15分钟和30分钟增加35%(P=0.007)，而冠脉阻力降低23%(P=0.036)。心肌耗氧量下降8%(P=0.043)。结论奈西立肽对冠脉传导和阻力血管均有扩张作用。尽管冠脉灌注压降低，但冠状动脉血流量增加，冠脉阻力降低，心肌摄氧量减少。
Background - Nesiritide, recombinant human B-type natriuretic peptide, has been shown to be efficacious in the treatment of decompensated heart failure. The effects of intravenous nesiritide on the human coronary vasculature have not been studied.Methods and Results - Ten patients underwent right and left heart catheterization. Baseline coronary blood flow was determined using quantitative coronary angiography (QCA) and an intracoronary Doppler-tipped guidewire. Myocardial oxygen uptake was measured using a coronary sinus catheter. Patients then received an intravenous infusion of nesiritide (2 mug/kg bolus followed by 0.01 mug/kg per min infusion) for 30 minutes. Right atrial pressure decreased 52% (P = 0.012), pulmonary artery mean pressure decreased 19% (P = 0.03), pulmonary capillary wedge pressure decreased 46% (P = 0.002), and mean arterial pressure decreased 11% (P = 0.007). QCA demonstrated a 15% increase in coronary artery diameter from a baseline of 2.6 +/- 0.8 to 3.0 +/- 0.8 mm at 30 minutes (P = 0.007). The coronary velocity measure of average peak velocity increased 14% from 20.8 +/- 6.4 at baseline to 23.8 +/- 7.2 cm/s at 5 minutes (P = 0.015) and then returned to baseline for the remainder of the infusion. Coronary blood flow increased 35% (P = 0.007), whereas coronary resistance decreased 23% at 15 and 30 minutes (P = 0.036). Myocardial oxygen uptake decreased 8% during the nesiritide infusion ( P = 0.043).Conclusions - Nesiritide exerts coronary vasodilator effects on both the coronary conductance and resistance arteries. Despite a decrease in coronary perfusion pressure, coronary artery blood flow is increased, coronary resistance is decreased, and myocardial oxygen uptake is decreased.