Out-Patients Treated With Nesiritide Show Reduced Cardio Remodeling, Significant Improvements in Heart Function

In a study presented here on September 14, at the Heart Failure Society of America 8th Annual Scientific Meeting, it was shown that among a small group of patients with heart failure and moderate to severe impairment of LV performance, weekly infusions of nesiritide could significantly reduce, even reverse myocardial remodeling, and improve hemodynamic parameters.

Twenty-eight patients, mean age 73.5 years, had either ischemic or hypertensive heart disease, or atrio-ventricular valve defects. They were followed for an 18-month period. At baseline, all patients were NYHA class III or IV, and the mean classification was 3.8.

Following 12 months of therapy, there were marked improvements in most measures of cardio performance. At baseline, LV diastolic dysfunction was seen in 94.5% of patients, but at 1-year follow up, was seen in only 37% of patients. Ventricular arrhythmia was reduced from 26.3% to 8.9%. Atrial fibrillation was seen in 25% of patients at baseline and in 6.3% after 1 year of follow up.

Mean global LVEF increased from 29.3% at baseline to 33.9% at follow up.

With cardiac remodeling, left atrium size at baseline was 53 mm, which was reduced to 47 mm at follow up. LVID was reduced from 59 mm to 53 mm. The number of patients with at least moderate mitral regurgitation was reduced from 94% to 44%, while tricuspid regurgitation was reduced from 63% to 31.3%

Pulmonary arterial pressure was reduced from 52.3 mm Hg to 42 mm Hg.

Significant improvements were also seen in renal performance as measured by serum creatinine and blood-urea-nitrogen (41.07 mg/dL at baseline vs. 37.97 at follow up)

Three patients required further hospitalization for worsening heart failure during the study, and there were 2 cardiac deaths.

The study investigators, headed by Ambika Bhaskaran, MD, of the department of cardiology, Mesa General Hospital, Mesa, Arizona, concluded that weekly infusions of nesiritide resulted in significant reductions in mitral and tricuspid valve regurgitation, as well as significant improvements in hemodynamic parameters, left heart dimensions, left ventricular systolic performance, diastolic performance improvements for both ventricles, and reductions in PAP.

All of these translated into significant improvements in NYHA class at the end of 1 year, with resulting improvements in terms of reduced hospitalization, lower use of medications, and a low rate of cardiac mortality or worsening heart failure.

The authors concluded that nesiritide can provide significant short-term benefits to heart failure patients when used in an out-patient setting although as with any patients, including those who are hospitalized, close monitoring would still be required. Longer term results are still pending.