Objectives To compared and evaluated the acute haemodynamic effects and safety of intravenous rhBNP versus nitroglycerin (NIT) in AMI patients with ADHF by Swan-Ganz catheter (6F, ARROW, Inc USA) monitoring through a prospectively designed study.
Methods 42 consecutive AMI patients with ADHF were randomised into rhBNP group (n=21, 1.5 μg·kg−1 bolus intravenous injection followed by 0.0075 μg·kg−1·min−1 for the first 3 h and 0.015–0.03 μgċkg−1·min−1 infusion for following 21 h) and NIT group (n=21, 10 to 100 μg·min−1 intravenous infusion for 24 h). The invasive haemodynamic parameters were measured at the baseline, during 24 h of drug infusion and 6 h of post-infusion by Swan-Ganz catheter monitoring via subclavian access while total urine output during 30 h and relative serum chemistries were measured. MACE was followed up 1 week.
Results As early as 30 min after the initiation of rhBNP, PCWP was reduced by 48.9% contrasted to baseline and cardiac index (CI) was increased by 27.1% at 1 h of rhBNP infusion respectively, (p<0.05); these significant changes in PCWP and CI continued throughout 24 h of rhBNP infusion and 6 h of discontinuing the infusion (p<0.05). Although PCWP reduced significantly at 2 h of NIT infusion (p<0.05) and CI elevated significantly at 3 h of infusion. The total urine output for 30 h of this study in rhBNP group tended to be more than that in NIT group (p>0.05), while serum potassium concentration in rhBNP group was significantly increased relative to baseline value (3.4±0.5 vs 4.0±0.4 mmol·L−1, p<0.05). There was no symptomatic hypotension or other adverse events appeared to be associated with rhBNP administration under this study.
Conclusions Intravenous injection of rhBNP results in more rapid, strong and prolong haemodynamic improvement than that of NIT in AMI patients with ADHF as well it is also feasible and safe in clinic as a selective agent for AMI patients with ADHF.