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Acute coronary syndromes
B-type natriuretic peptide infusions in acute myocardial infarction
  1. R J Hillock,
  2. C M Frampton,
  3. T G Yandle,
  4. R W Troughton,
  5. J G Lainchbury,
  6. A M Richards
  1. Christchurch Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences and Christchurch Hospital, Christchurch, New Zealand
  1. Professor A M Richards, Department of Medicine, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand; mark.richards{at}cdhb.govt.nz

Abstract

Background: Natriuretic peptides have actions likely to ameliorate cardiac dysfunction. B-type natriuretic peptide (BNP) is indicated as treatment for decompensated cardiac failure.

Objective: To determine the utility of BNP in acute myocardial infarction (MI).

Design: Double-blind randomised placebo-controlled trial.

Setting: Tertiary hospital coronary care unit.

Patients: 28 patients with acute MI with delayed or failed reperfusion and moderate left ventricular dysfunction.

Interventions: Infusion of BNP or placebo for 60 hours after MI.

Main outcome measures: Neurohormonal activation and renal function in response to BNP infusion, secondary end points of echocardiographic measures of left ventricular function and dimension.

Results: BNP infusion resulted in a significant rise in BNP (276 pg/l vs 86 pg/l, p = 0.001). NT-proBNP levels were suppressed by BNP infusion (p = 0.002). Atrial natriuretic peptide (ANP) and NT-proANP levels fell with a significant difference in the pattern between BNP infusion and placebo during the first 5 days (p<0.005). C-type natriuretic peptide (CNP) and NT-proCNP levels rose during the infusion with higher levels than placebo at all measurements during the first 3 days (p<0.01). Cyclic guanosine monophosphate (cGMP) was raised during the infusion period showing a peak of 23 pmol/l on day 2 (placebo 8.9 pmol/l, p = 0.002), with a correlation between BNP and cGMP levels (p<0.001). Glomerular filtration rate (GFR) fell with BNP infusion but was not significantly lower than with placebo (71.0 (5.6) vs 75.8 (5.4) ml/min/1.73 m2, p = 0.62). Patients receiving nesiritide exhibited favourable trends in left ventricular remodelling.

Conclusions: Nesiritide, given soon after MI, induced increments in plasma cGMP and CNP and decrements in other endogenous cardiac peptides with a neutral effect on renal function and a trend towards favourable ventricular remodelling.

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Footnotes

  • Funding: Scios Incorporated is a Johnson and Johnson company which supplied the nesiritide free of charge. Scios Inc was not involved in the design, execution, analysis, or reporting of this trial.

  • Competing interests: None.

  • Ethics approval: Approved by an ethics committee of the New Zealand Department of Health.

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