HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O’Dell, K. M. Articles by Czerska, B. Search for Related Content PubMed PubMed Citation Articles by O’Dell, K. M. Articles by Czerska, B.

KATE M. O’DELL, PHARM.D., is Assistant Professor, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, and Travis Regional Coordinator, Department of Pharmacy, David Grant Medical Center, Fairfield, CA; when this study was performed she was Pharmacy Specialist, Department of Pharmacy Services, Henry Ford Hospital (HFH), Detroit, MI. JAMES S. KALUS, PHARM.D., is Assistant Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, and Clinical Specialist, Department of Pharmacy Services, HFH. SUZAN KUCUKARSLAN, PH.D., B.S.PHARM., is Manager, Center for Drug Use Analysis and Information, Department of Pharmacy Services, and BARBARA CZERSKA, M.D., is Director, Heart Failure and Transplant Section, Heart and Vascular Institute, HFH.

Address correspondence to Dr. O’Dell at the Department of Pharmacy, David Grant Medical Center, 101 Bodin Circle, Fairfield, CA 94535 (kodell{at}pacific.edu).

Purpose. The impact of adding nesiritide to standard therapy and positive inotropic agents in patients with end-stage heart failure and secondary pulmonary hypertension (PH) was studied. Methods. Patients included in this retrospective study were 18 years of age or older, admitted to the hospital with PH secondary to end-stage heart failure (New York Heart Association functional class IV), had received a pulmonary artery catheter, had been treated with nesiritide because of inadequate hemodynamic response to previous therapy (pulmonary capillary wedge pressure [PCWP], >18 mm Hg), and had shown minimal symptomatic benefit from standard heart-failure therapy, continuous infusions of loop diuretics, and positive inotropic agents (milrinone or dobutamine or both). The primary endpoint was change in PCWP. Secondary endpoints included change in mean pulmonary artery pressure (MPAP), change in cardiac index (CI), change in mean arterial pressure (MAP), change in serum creatinine (SCr) concentration, and occurrence of symptomatic hypotension. Results. The study included 33 patients. Mean PCWP was reduced by 31.1% with the addition of nesiritide to previous therapy (p < 0.0001). Significant improvements in other hemodynamic variables, including MPAP (15.6% reduction) and CI (13.0% increase), were also observed. MAP was reduced significantly (by 15.2%), but SCr concentration did not change. There were five episodes of symptomatic hypotension. All patients exhibited relief of dyspnea symptoms. Conclusion. The addition of nesiritide to standard therapy and positive inotropic agents improved hemodynamic measures and clinical symptoms in patients with end-stage heart failure and secondary pulmonary hypertension. Index terms: Cardiac drugs; Combined therapy; Heart failure; Hypertension; Nesiritide; Toxicity

 

This article has been cited by other articles:

				L. U. Nwakanma, A. S. Shah, J. V. Conte, and W. A. Baumgartner Heart Transplantation Card. Surg. Adult, January 1, 2008; 3(2008): 1539 - 1578. [Full Text]