Effects of long-term intravenous administration of adrenomedullin (AM) plus hANP therapy in acute decompensated heart failure: a pilot study.
BACKGROUND
It was reported previously that 30 min administration of adrenomedullin (AM) improves hemodynamics in chronic stable heart failure patients. The present study was designed to examine whether long-term AM + human atrial natriuretic peptide (hANP) administration can be used as a therapeutic drug in patients with acute decompensated heart failure (ADHF) in clinical setting.


RESULTS
Seven acute heart failure patients (74 +/- 5 years) with dyspnea and pulmonary congestion were studied. AM (0.02 microg x kg(-1) x min(-1)) + hANP (0.05 microg x kg(-1) x min(-1)) was infused for 12 h and then hANP (0.05 microg x kg(-1) x min(-1)) was infused for 12 h. Hemodynamic, renal, hormonal and oxidative stress responses were evaluated. AM + hANP significantly reduced mean arterial pressure, pulmonary arterial pressure and systemic and pulmonary vascular resistance without changing heart rate, and increased cardiac output for most time-points compared with those at baseline. In addition, AM + hANP reduced aldosterone, brain natriuretic peptide and free-radical metabolites compared with those at baseline (all P<0.05). AM + hANP increased urine volume and U(Na)V compared with baseline data.


CONCLUSIONS
In this small, pilot trial, AM + hANP therapy had beneficial hemodynamic and hormonal effects in ADHF. Intravenous infusion of AM with hANP could be used as a therapeutic drug in ADHF. These data are preliminary and require confirmation in a larger clinical study.
Nishikimi
Toshio
T
Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University, Mibu, Japan. nishikim@dokkyomed.ac.jp
Karasawa
Tsuyoshi
T
Inaba
Chikako
C
Ishimura
Kimihiko
K
Tadokoro
Kazuyoshi
K
Koshikawa
Shogo
S
Yoshihara
Fumiki
F
Nagaya
Noritoshi
N
Sakio
Hideaki
H
Kangawa
Kenji
K
Matsuoka
Hiroaki
H
D000208:Acute Disease; D053607:Adrenomedullin / Q000008:administration & dosage* / Q000097:blood; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D018384:Oxidative Stress / Q000187:drug effects; D010865:Pilot Projects; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics / Q000187:drug effects
D015415:Biomarkers; D002317:Cardiovascular Agents; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor