静脉注射奈西立肽对肺动脉高压患者肺血管血流动力学的影响。

Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension.

作者信息

Michaels Andrew D, Chatterjee Kanu, De Marco Teresa

机构信息

Division of Cardiology, Department of Medicine, University of California at San Francisco Medical Center, 94143, USA.

出版信息

J Card Fail. 2005 Aug;11(6):425-31. doi: 10.1016/j.cardfail.2005.01.009.

DOI:10.1016/j.cardfail.2005.01.009

PMID:16105633

Abstract

BACKGROUND

Nesiritide is effective in the treatment of decompensated heart failure (HF). We evaluated the acute hemodynamic effects of nesiritide, a recombinant B-type natriuretic peptide, in patients with HF and pulmonary hypertension (PH).

METHODS AND RESULTS

Twenty patients with HF and PH (mean pulmonary arterial [PA] pressure >25 mm Hg) were enrolled: 10 with postpulmonary capillary wedge (PCW) >15 mm Hg and 10 with precapillary PH (PCW) < or =15. The pulmonary and systemic hemodynamics were determined by right heart catheterization at baseline and at 15 and 30 minutes after an intravenous nesiritide infusion (2 mcg/kg bolus and 0.01 mcg.kg.min). For the patients with postcapillary PH, the mean left ventricular ejection fraction was 28 +/- 15%. After the 30-minute nesiritide infusion, right atrial (RA) pressure decreased 48% (P < .0001), mean PA pressure decreased 29% (P < .0001), PCW pressure decreased 40% (P < .0001), cardiac index (CI) increased 35% (P = .009), pulmonary vascular resistance index (PVRI) decreased 35% (P = .01), and arteriovenous oxygen difference (AVDO(2)) decreased 27% (P = .0003). For precapillary PH patients, there was no change in RA, PA, or PCW pressure, nor any change in CI, PVRI, or AVDO(2).

CONCLUSIONS

Nesiritide acutely and significantly reduced PA pressure, PVRI, and biventricular filling pressures in patients with postcapillary PH. However, for patients with precapillary PH, nesiritide had no significant acute hemodynamic effect on the pulmonary hemodynamics. The lack of acute beneficial effects of nesiritide in patients with advanced precapillary PH may be related to their relatively fixed remodeling of the pulmonary vasculature.

摘要

背景

奈西立肽对失代偿性心力衰竭（HF）有效。我们评估了重组B型利钠肽奈西立肽对心力衰竭合并肺动脉高压（PH）患者的急性血流动力学影响。

方法与结果

纳入20例心力衰竭合并肺动脉高压患者（平均肺动脉[PA]压>25 mmHg）：10例肺毛细血管楔压（PCW）>15 mmHg，10例毛细血管前性肺动脉高压（PCW）≤15 mmHg。在基线时以及静脉输注奈西立肽（2 mcg/kg负荷剂量，随后0.01 mcg·kg·min）后15分钟和30分钟时，通过右心导管检查测定肺和全身血流动力学。对于毛细血管后性肺动脉高压患者，平均左心室射血分数为28±15%。输注奈西立肽30分钟后，右心房（RA）压降低48%（P<.0001），平均PA压降低29%（P<.0001），PCW压降低40%（P<.0001），心脏指数（CI）增加35%（P=.009），肺血管阻力指数（PVRI）降低35%（P=.01），动静脉血氧差（AVDO₂）降低27%（P=.0003）。对于毛细血管前性肺动脉高压患者，RA、PA或PCW压无变化，CI、PVRI或AVDO₂也无变化。