Division of Cardiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah 84132-2401, USA.
J Card Fail. 2009 Oct;15(8):673-80. doi: 10.1016/j.cardfail.2009.03.004. Epub 2009 May 21.
Nesiritide is recombinant human B-type natriuretic peptide with vasodilatory effects used in patients with decompensated congestive heart failure. We sought to evaluate the effects of nesiritide on left ventricular diastolic function in heart failure patients.
Twenty-five heart failure patients underwent left heart catheterization (using a pressure-volume conductance catheter) and echocardiography at baseline and 30 minutes after an intravenous bolus and infusion of nesiritide. Invasive and noninvasive measurements of load-dependent (deceleration time, echocardiographic diastolic function classification, negative dP/dt, left ventricular diastolic pressure, tau) parameters of diastolic function were assessed. The nonlinear slope of the end-diastolic pressure volume relationship (EDPVR) using 2 single-beat methods for measuring left ventricular end-diastolic elastance was calculated to assess load-independent parameters of diastolic function. Nesiritide reduced biventricular diastolic pressure and systemic vascular resistance. Tau and negative dP/dt showed modest improvement. Deceleration time, isovolumetric relaxation time, diastolic stiffness indices (E/E'/stroke volume (SV) and E/E'/left ventricular end-diastolic volume index (LVEDVI)), and the echocardiographic diastolic filling pattern classification did not change. Furthermore, there was no change in the EDPVR.
Although nesiritide is an effective vasodilator resulting in decreased left ventricular preload and afterload in heart failure patients, intrinsic left ventricular diastolic function did not change acutely, suggesting that nesiritide has no significant acute lusitropic effect.
奈西立肽是一种重组人 B 型利钠肽，具有血管扩张作用，用于治疗失代偿性充血性心力衰竭患者。我们旨在评估奈西立肽对心力衰竭患者左心室舒张功能的影响。
25 例心力衰竭患者在基线时和静脉推注奈西立肽 30 分钟后进行左心导管检查（使用压力-容积导丝导管）和超声心动图检查。评估负荷依赖性（减速时间、超声心动图舒张功能分类、负 dP/dt、左心室舒张末期压力、tau）和非负荷依赖性（舒张末期压力-容积关系的非线性斜率，使用 2 种测量左心室舒张末期弹性的单心动周期方法来评估舒张功能的参数）舒张功能参数。奈西立肽降低了双心室舒张末期压力和全身血管阻力。tau 和负 dP/dt 略有改善。减速时间、等容舒张时间、舒张僵硬度指数（E/E'/心搏量（SV）和 E/E'/左心室舒张末期容积指数（LVEDVI））和超声心动图舒张充盈模式分类没有变化。此外，舒张末期压力-容积关系也没有变化。
尽管奈西立肽是一种有效的血管扩张剂，可降低心力衰竭患者的左心室前负荷和后负荷，但左心室固有舒张功能并未急性改变，提示奈西立肽对左心室没有明显的急性变力作用。
