Department of Cardiology De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy.
Int J Cardiol. 2022 Dec 15;369:37-44. doi: 10.1016/j.ijcard.2022.08.009. Epub 2022 Aug 6.
Despite evidence of hemodynamic benefit of sodium nitroprusside (SNP) treatment for acute heart failure (AHF), there are limited data about its efficacy and safety. This study aimed to assess the effectiveness and safety of SNP treatment, to explore the impact of N-terminal pro-B natriuretic peptide (NT-proBNP) reduction on clinical endpoints and to identify possible predictors of clinical response.
Multicenter retrospective cohort study of 200 patients consecutively admitted for AHF in 2 Italian Centers. Primary endpoint was the reduction of NT-proBNP levels ≥25% from baseline values within 48 h from the onset of SNP infusion. Secondary and safety endpoints included all-cause mortality, rehospitalization for HF at 1, 3 and 6 months, length of hospital stay (LOS) and severe hypotension. 131 (66%) patients experienced a NT-proBNP reduction ≥25% within 48 h from treatment onset, irrespective of initial systolic blood pressure (SBP). Left ventricular end diastolic diameter (LVEDD) was the only independent predictor of treatment efficacy. Patients who achieved the primary endpoint (i.e., 'responders') had lower LOS (median 15 [IQR:10-27] vs 19 [IQR:12-35] days, p-value = 0.033) and a lower incidence of all-cause mortality and rehospitalization for HF at 1 and 3 months compared to "non responders" (p-value <0.050). Severe hypotension was observed in 10 (5%) patients, without any adverse clinical consequence.
SNP is a safe and effective treatment of AHF, particularly in patients with dilated left ventricle. Reduced NT-proBNP levels in response to SNP is associated to shorter LOS and lower risk of 1- and 3-month re-hospitalizations for HF.
gov. Unique identifier: NCT05027360.
尽管有证据表明硝普钠（SNP）治疗急性心力衰竭（AHF）可改善血液动力学，但关于其疗效和安全性的数据有限。本研究旨在评估 SNP 治疗的有效性和安全性，探讨 N 末端 pro-B 型利钠肽（NT-proBNP）降低对临床终点的影响，并确定临床反应的可能预测因素。
这是一项在意大利的 2 家中心进行的多中心回顾性队列研究，共纳入了 200 例连续因 AHF 入院的患者。主要终点是 SNP 输注开始后 48 小时内从基线值降低 NT-proBNP 水平≥25%。次要和安全性终点包括全因死亡率、1、3 和 6 个月时因 HF 再住院、住院时间（LOS）和严重低血压。131 例（66%）患者在治疗开始后 48 小时内 NT-proBNP 降低≥25%，与初始收缩压（SBP）无关。左心室舒张末期直径（LVEDD）是治疗效果的唯一独立预测因素。达到主要终点（即“应答者”）的患者 LOS 更短（中位数 15 [IQR：10-27] 与 19 [IQR：12-35] 天，p 值=0.033），并且在 1 个月和 3 个月时全因死亡率和因 HF 再住院的发生率均低于“非应答者”（p 值均＜0.050）。10 例（5%）患者出现严重低血压，但无任何不良临床后果。
SNP 是治疗 AHF 的一种安全有效的方法，尤其适用于左心室扩张的患者。对 SNP 有反应的 NT-proBNP 水平降低与 LOS 缩短以及 HF 1-3 个月再住院风险降低相关。
