Effects of intravenous nesiritide on human coronary vasomotor regulation and myocardial oxygen uptake.
BACKGROUND
Nesiritide, recombinant human B-type natriuretic peptide, has been shown to be efficacious in the treatment of decompensated heart failure. The effects of intravenous nesiritide on the human coronary vasculature have not been studied.


RESULTS
Ten patients underwent right and left heart catheterization. Baseline coronary blood flow was determined using quantitative coronary angiography (QCA) and an intracoronary Doppler-tipped guidewire. Myocardial oxygen uptake was measured using a coronary sinus catheter. Patients then received an intravenous infusion of nesiritide (2 microg/kg bolus followed by 0.01 microg/kg per min infusion) for 30 minutes. Right atrial pressure decreased 52% (P=0.012), pulmonary artery mean pressure decreased 19% (P=0.03), pulmonary capillary wedge pressure decreased 46% (P=0.002), and mean arterial pressure decreased 11% (P=0.007). QCA demonstrated a 15% increase in coronary artery diameter from a baseline of 2.6+/-0.8 to 3.0+/-0.8 mm at 30 minutes (P=0.007). The coronary velocity measure of average peak velocity increased 14% from 20.8+/-6.4 at baseline to 23.8+/-7.2 cm/s at 5 minutes (P=0.015) and then returned to baseline for the remainder of the infusion. Coronary blood flow increased 35% (P=0.007), whereas coronary resistance decreased 23% at 15 and 30 minutes (P=0.036). Myocardial oxygen uptake decreased 8% during the nesiritide infusion (P=0.043).


CONCLUSIONS
Nesiritide exerts coronary vasodilator effects on both the coronary conductance and resistance arteries. Despite a decrease in coronary perfusion pressure, coronary artery blood flow is increased, coronary resistance is decreased, and myocardial oxygen uptake is decreased.
Division of Cardiology, Department of Medicine, University of California at San Francisco Medical Center, 505 Parnassus Ave, Box 0124, San Francisco, Calif 94143-0124, USA. andrewm@itsa.ucsf.edu
Andrew D
AD
Michaels
Andrew
A
Klein
James A
JA
Madden
Kanu
K
Chatterjee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000187:drug effects; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D045283:Natriuretic Agents / Q000494:pharmacology*; D020097:Natriuretic Peptide, Brain; D010101:Oxygen Consumption / Q000187:drug effects*; D011446:Prospective Studies; D018084:Ultrasonography, Interventional; D014655:Vascular Resistance / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects; D014666:Vasomotor System / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain