Treatment with B-type natriuretic peptide for chronic decompensated heart failure: Insights learned from the Follow-Up Serial Infusion of Nesiritide (FUSION) trial

被引:15
作者
Yancy, CW [1 ]
机构
[1] Univ Texas, SW Med Ctr, Dallas, TX USA
关键词
heart failure; inotropic therapy; left ventricular dysfunction; natriuretic peptide;
D O I
10.1007/s10741-005-6132-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Several evidence-based treatment regimens are modestly effective in patients with moderately severe to severe heart failure, but truly effective therapies that improve symptoms, reduce hospitalizations, and extend meaningful survival do not exist for these patients. Only ventricular replacement therapy, with either heart transplantation or left ventricular assist devices, has been shown to significantly improve outcomes. Nesiritide, a recombinant B-type natriuretic peptide, is associated with significant reductions in filling pressure, with corresponding relief of symptoms, and diminished neurohormonal levels and has no inotropic effects and no evidence of proarrhythmia when given to patients with decompensated acute heart failure. Results of the Follow-Up Serial Infusion of Nesiritide (FUSION) trial suggest that a regimen incorporating nesiritide can be accomplished with a reasonable assurance of safety and tolerability; pre-study concerns regarding hypotension were not realized. A qualified look at outcomes data within FUSION I suggests that further study of this paradigm is reasonable, especially if the studied patient population includes patients with a low left ventricular ejection fraction and New York Heart Association (NYHA) class III disease with renal insufficiency, or patients with low left ventricular ejection fraction and NYHA class IV heart failure. Therefore, FUSION II, a double-blind, placebo-controlled trial, will randomly assign approximately 900 such patients to treatment with usual care plus nesiritide or usual care plus placebo and will use mortality/cardiorenal hospitalization as a composite end point. If positive data emerge from FUSION II that either confirm or strengthen the data in FUSION I, a new therapeutic option may be available for patients with chronic decompensated heart failure.
引用
收藏
页码:209 / 216
页数:8
相关论文
共 32 条
[1]  
Abraham W T, 1998, J Card Fail, V4, P37, DOI 10.1016/S1071-9164(98)90506-1
[2]   Intravenous Nesiritide (Human B-Type natriuretic peptide) reduces plasma endothelin-1 levels in patients with decompensated congestive heart failure [J].
Aronson, D ;
Burger, AJ .
AMERICAN JOURNAL OF CARDIOLOGY, 2002, 90 (04) :435-+
[3]  
ARONSON D, 2002, J AM COLL CARDIOL S, V39, pB403
[4]   Recent advances in natriuretic peptides in congestive heart failure [J].
Boerrigter, G ;
Burnett, JC .
EXPERT OPINION ON INVESTIGATIONAL DRUGS, 2004, 13 (06) :643-652
[5]   Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects [J].
Brunner-La Rocca, HP ;
Kaye, DM ;
Woods, RL ;
Hastings, J ;
Esler, MD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 37 (05) :1221-1227
[6]   Effect of nesiritide (B-type natriuretic peptide) and dobutamine on ventricular arrhythmias in the treatment of patients with acutely decompensated congestive heart failure: The PRECEDENT study [J].
Burger, AJ ;
Horton, DP ;
LeJemtel, T ;
Ghali, JK ;
Torre, G ;
Dennish, G ;
Koren, M ;
Dinerman, J ;
Silver, M ;
Cheng, ML ;
Elkayam, U .
AMERICAN HEART JOURNAL, 2002, 144 (06) :1102-1108
[7]   Comparison of the occurrence of ventricular arrhythmias in patients with acutely decompensated congestive heart failure receiving dobutamine versus nesiritide therapy [J].
Burger, AJ ;
Elkayam, U ;
Neibaur, MT ;
Haught, H ;
Ghali, J ;
Horton, DP ;
Aronson, D .
AMERICAN JOURNAL OF CARDIOLOGY, 2001, 88 (01) :35-39
[8]   The efficacy and safety of B-type natriuretic peptide (nesiritide) in patients with renal insufficiency and acutely decompensated congestive heart failure [J].
Butler, J ;
Emerman, C ;
Peacock, WF ;
Mathur, VS ;
Young, JB .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2004, 19 (02) :391-399
[9]   A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST) [J].
Califf, RM ;
Adams, KF ;
McKenna, WJ ;
Gheorghiade, M ;
Uretsky, BF ;
McNulty, SE ;
Darius, H ;
Schulman, K ;
Zannad, F ;
HandbergThurmond, E ;
Harrell, FE ;
Wheeler, W ;
SolerSoler, J ;
Swedberg, K .
AMERICAN HEART JOURNAL, 1997, 134 (01) :44-54
[10]  
Coffin M R, 1994, J Intraven Nurs, V17, P145