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:	Ochiai ME; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil., Brancalhão EC; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil., Puig RS; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil., Vieira KR; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil., Cardoso JN; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil., Oliveira MT Jr; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil., Barretto AC; Heart Institute (InCor), Cotoxó Hospital, Universidade de São Paulo, São Paulo, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Clinics (Sao Paulo, Brazil) [Clinics (Sao Paulo)] 2014; Vol. 69 (5), pp. 308-13.
DOI:	10.6061/clinics/2014(05)02
Abstrakt:	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.
Databáze:	MEDLINE
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