Low-dose nesiritide in human anterior myocardial infarction suppresses aldosterone and preserves ventricular function and structure: a proof of concept study.
Low-dose nesiritide in human anterior myocardial infarction suppresses aldosterone and preserves ventricular function and structure: a proof of concept study.
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DOI：
10.1136/hrt.2008.153916
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发表时间：
2009-08
期刊：
影响因子：
--
通讯作者：
Burnett JC Jr
中科院分区：
文献类型：
--
作者：
Chen HH;Martin FL;Gibbons RJ;Schirger JA;Wright RS;Schears RM;Redfield MM;Simari RD;Lerman A;Cataliotti A;Burnett JC Jr
B型利钠肽（BNP，奈西立肽）具有抗纤维化、抗肥大、抗炎、血管舒张、促收缩和醛固酮抑制特性，但常规剂量的BNP会引起低血压，限制了其在心力衰竭中的使用。确定前壁急性心肌梗死（AMI）成功再灌注后24小时内输注低剂量BNP是否可以预防不良左心室（LV）重构并抑制醛固酮。进行了一项转化概念验证研究，以确定0.003和0.006 mg/kg/min静脉内BNP的耐受性和生物活性，在前壁AMI成功再灌注后24小时内未开始推注。24例首次前壁ST段抬高AMI和成功血运重建的患者被随机分配接受0.003（n = 12）或0.006（n = 12）mg/kg/min的IV BNP治疗72 h，在前壁AMI住院期间接受标准治疗。两组之间的基线特征、药物和心肌损伤的峰值心脏生物标志物相似。以0.006 mg/kg/min输注BNP比以0.003 mg/kg/min输注产生更大的生物活性，如通过更高的平均（SEM）血浆cGMP水平所测量的（8.6（1）vs 5.5（1）pmol/ml，p，0.05）和血浆醛固酮抑制（8.0（2）至4.6（1）ng/ dl，p，0.05），0.003 mg/kg/min组未观察到。0.006组的左心室射血分数（LVEF）从基线至1个月显著改善（40（4）%至54（5）%，p，0.05），但0.003组无改善。以0.006 mg/kg/min输注BNP与1个月时LV收缩末期容积指数降低（61（9）至43（8）ml/m2，p，0.05）相关，而在0.003组中未观察到。两组均未发生药物相关严重不良事件。在前壁AMI时输注低BNP 72 h耐受性良好且具有生物活性。接受低剂量BNP治疗的患者在1个月时LVEF改善，LV收缩末期容积较小。
B-type natriuretic peptide (BNP, nesiritide) has anti-fibrotic, anti-hypertrophic, anti-inflammatory, vasodilating, lusitropic and aldosterone-inhibiting properties but conventional doses of BNP cause hypotension, limiting its use in heart failure. To determine whether infusion of low-dose BNP within 24 h of successful reperfusion for anterior acute myocardial infarction (AMI) would prevent adverse left ventricular (LV) remodelling and suppress aldosterone. A translational proof-of-concept study was carried out to determine tolerability and biological activity of intravenous BNP at 0.003 and 0.006 mg/kg/min, without bolus started within 24 h of successful reperfusion for anterior AMI. 24 patients with first anterior wall ST elevation AMI and successful revascularisation were randomly assigned to receive 0.003 (n = 12) or 0.006 (n = 12) mg/kg/min of IV BNP for 72 h in addition to standard care during hospitalisation for anterior AMI. Baseline characteristics, drugs and peak cardiac biomarkers for myocardial damage were similar between both groups. Infusion of BNP at 0.006 mg/kg/min resulted in greater biological activity than infusion at 0.003 mg/kg/min as measured by higher mean (SEM) plasma cGMP levels (8.6 (1) vs 5.5 (1) pmol/ml, p,0.05) and suppression of plasma aldosterone (8.0 (2) to 4.6 (1) ng/ dl, p,0.05), which was not seen in the 0.003 mg/kg/min group. LV ejection fraction (LVEF) improved significantly from baseline to 1 month (40 (4)% to 54 (5)%, p,0.05) in the 0.006 group but not in the 0.003 group. Infusion of BNP at 0.006 mg/kg/min was associated with a decrease of LV end-systolic volume index (61 (9) to 43 (8) ml/m2, p,0.05) at 1 month, which was not seen in the 0.003 group. No drug-related serious adverse events occurred in either group. 72 h infusion of low BNP at the time of anterior AMI is well tolerated and biologically active. Patients treated with low-dose BNP had improved LVEF and smaller LV end-systolic volume at 1 month.
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影响因子：
37.8
作者：
Adams, RJ;Antman, EM;Kavey, REW
通讯作者：
Kavey, REW
影响因子：
37.8
作者：
Michaels, AD;Klein, A;Chatterjee, K
通讯作者：
Chatterjee, K
影响因子：
20.1
作者：
Tsuruda, T;Boerrigter, G;Burnett, JC
通讯作者：
Burnett, JC
DOI：
10.1016/s0735-1097(01)01233-5
发表时间：
2001-06-01
影响因子：
24
作者：
Hayashi, M;Tsutamoto, T;Kinoshita, M
通讯作者：
Kinoshita, M
影响因子：
24
作者：
Kasama, Shu;Toyama, Takuji;Kurabayashi, Masahiko
通讯作者：
Kurabayashi, Masahiko