| Background and aims Heart failure is a clinical syndrome with molecular abnormality which is caused by multiple heart diseases that lead to abnormality of the heart structure and function, impair ventricular filling and/or pump function, decrease cardiac output and increase venous pressure and is accompanied by the progressive degradation of the failing heart and premature death of cardiomyocytes. According to the hemodynamics, heart failure can be divided into backward failure and forward failure. Patients can present with signs and symptoms such as dyspnea, increase in jugular venous pressure, edema, fatigue, decrease in exercise tolerance and cold acra. Acute decompensated heart failure (ADHF) is a progressive stage of heart failure and clinical syndrome induced by several causes, which may develop on the basis of initial chronic heart failure and acutely progress into decompensated stage and typically present as dyspnea and edema. The hemodynamic manifestations are increase in PCWP and decrease in cardiac index, which may pose a lethal threat to ADHF patients. More effective drugs for the treatment of heart failure are still actively sought for in current clinical setting, especially those for ADHF. Recombinant human brain natriuretic peptide (rhBNP) has the same molecular structure and spatial conformation, which can act very similarly to human BNP. rhBNP was first used to treat ADHF in 1996 and is now being widely used internationally and has attained satisfying efficacy. It can improve the hemodynamics of ADHF patients and further alleviate their symptoms. In the relevant studies both home and abroad, effects of rhBNP was usually compared with those of other commonly used ADHF drugs, such as nitroglycerin, dobutamine and milrinone. In our clinical experience we found that rhBNP is more effective for the treatment of ADHF patients with relatively more severe H2O/[Na+] retention, whereas its effect is less apparent on patients whose symptoms of heart failure have little to do with conditions such as H2O/[Na+] retention that increases cardiac load. Our study was carried out based on the above observations and aimed to compare the difference in acute hemodynamic effect and efficacy of rhBNP for the treatment of patients with moderate-to-heavy H2O/[Na+] retention and those with mild H2O/[Na+] retention.Methods Fourty ADHF patients enrolled in our hospital were allocated to experiment group (moderate to heavy severity, 20 cases) and control group (mild severity, 20 cases) according to the extent of H2O/[Na+] retention. Ten patients out of each group were randomized to have their hemodynamics monitored with Swan-Ganz .Pulmonary capillary wedge pressure(PCWP),,pulmonary artery pressure(PAP) and right atrial pressure (RAP)were recorded and cardiac output(CO) and cardiac index (CI)were assessed by heat-sensitive dilution method before drug administration and 0.5, 1, 3, 6 and 24h after drug administration.. All patients received rhBNP with an initial intravenous bolus of 2μg/kg, followed by continuous intravenous titration of 0. 01μg/(kg·min) for 24h.. Dyspnea, overall symptom improvements in clinical conditions and fluid input and output were recorded before and 0.5, 1, 3, 6 and 24h after drug administration. Results The changes of dyspnea and overall symptom were found more improved significantly in experiment group compared to control group , accompanied by enhanced natriuretic effect (2.7±0.8)L vs(1.7±0.4)L,P=0.01.. Patients in the experiment group experienced more rapid, apparent, stable and long-lasting declines in PCWP and RAP, and the declines were both significantly different. PAP in the two groups was not significantly different, and no significant differences in inter-group and intra-group CI were detected.Conclusions Compared to patients with mild H2O/[Na+] retention, ADHF patients with moderate-to-heavy H2O/[Na+] retention had more favorable acute hemodynamic profile and better clinical response to rhBNP treatment and might be the optimal target population for the clinical application of rhBNP treatment. |
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