Low-dose nesiritide in human anterior myocardial infarction suppresses aldosterone and preserves ventricular function and structure: a proof of concept study
- H H Chen1,2,
- F L Martin1,2,
- R J Gibbons2,
- J A Schirger1,2,
- R S Wright2,
- R M Schears3,
- M M Redfield1,2,
- R D Simari2,
- A Lerman2,
- A Cataliotti1,2,
- J C Burnett Jr1,2
- 1Cardiorenal Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- 2Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- 3Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Dr H H Chen, Cardiorenal Research Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55904, USA; chen.horng{at}mayo.edu
- Accepted 24 February 2009
- Published Online First 15 May 2009
Abstract
Background: 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.
Objective: 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.
Methods: A translational proof-of-concept study was carried out to determine tolerability and biological activity of intravenous BNP at 0.003 and 0.006 μg/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) μg/kg/min of IV BNP for 72 h in addition to standard care during hospitalisation for anterior AMI.
Results: Baseline characteristics, drugs and peak cardiac biomarkers for myocardial damage were similar between both groups. Infusion of BNP at 0.006 μg/kg/min resulted in greater biological activity than infusion at 0.003 μg/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 μg/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 μg/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.
Conclusions: 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.
Footnotes
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Funding: This work was supported by research grants from Scios Inc and the Mayo Foundation.
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Competing interests: HHC, MMR and JCB have received research grant from Scios Inc and the Mayo Clinic. JCB, RDS and HHC have patented and received royalties for designer natriuretic peptides. HHC has received royalties from Uptodate Inc. Mayo Clinic has patented and licensed designer natriuretic peptides.
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Ethics approval: Ethics committee approval from the Mayo Clinic Institutional Review Board.
