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

Autor(es)

Ochiai, Marcelo E. ^[1] ; Brancalhao, Euler C. O. ^[1] ; Puig, Raphael S. N. ^[1] ; Vieira, Kelly R. N. ^[1] ; Cardoso, Juliano N. ^[1] ; de Oliveira-, Jr., Mucio Tavares ^[1] ; Barretto, Antonio C. P. ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Heart Inst InCor, Cotoxo Hosp, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Clinics; v. 69, n. 5, p. 308-313, 2014.
• Citações Web of Science: 1

Resumo

OBJECTIVE: We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure. METHODS: We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction,<0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients 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. ClinicalTrials.gov:NCT01857999. RESULTS: We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg. min, indexed systemic vascular resistance 1918.0 dynes. sec/cm(5).m(2), cardiac index 2.8 L/min.m(2), and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, 49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements. CONCLUSION: Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence. (AU)

• Processo FAPESP: 06/06463-9 - Associação de bloqueador do receptor de angiotensina II com inibidor de enzima de conversão na insuficiência cardíaca descompensada com dependência de inotrópico endovenoso: efeitos hemodinâmicos, clínicos e sobre a mortalidade
• Beneficiário: Marcelo Eidi Ochiai
• Modalidade de apoio: Auxílio à Pesquisa - Regular