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Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial

Abstract

Objective was to evaluate the angiotensin receptor blocker add-on therapy in low cardiac output during decompensated heart failure.Methods. We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, ejection fraction < 0.45, and receiving an angiotensin-converting enzyme inhibitor. They were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. Results. We studied 10 patients in the losartan group and 11 patients in the placebo group. The patients characteristics were age 52.7 years, ejection fraction of 21.3%, dobutamine infusion of 8.5mcg/kg.min, indexed systemic vascular resistance of 1918.0 dynes.sec/cm5.m2, cardiac index of 2.8 L/min.m2, and and B-type natriuretic peptide of 1,403 pg/mL. After 7 days of intervention, there was a reduction of 37.4% in and B-type natriuretic peptide levels in the losartan group, compared with an increase of 11.9% in the placebo group (mean difference, -49.1%; 95% confidence interval: -88.1 to -9.8%, P = 0.018). No significant difference was found in hemodynamic measurements. Conclusion. Short-term add-on therapy with losartan reduced and B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence. (AU)

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