Abstract 2555: Nesiritide Improves Hemodynamics in Children with Dilated Cardiomyopathy: A Prospective Randomized Double-Blinded Placebo-Controlled Study
Introduction Nesiritide, a DNA recombinant form of B-type natriuretic peptide, has been demonstrated to improve the clinical status of adults with decompensated heart failure. The hemodynamic effects of nesiritide in children have not been previously reported in a controlled prospective study using a Swan-Ganz catheter. We hypothesized that nesiritide decreases pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and systolic blood pressure (SBP), and increases cardiac index (CI) in children with decompensated dilated cardiomyopathy.
Methods The study was a randomized, double-blinded, placebo-controlled trial. Inclusion criteria were: diagnosis of dilated cardiomyopathy, age less than 21 years, admission to the pediatric intensive care unit, and requirement of cardiac catheterization with Swan-Ganz catheter placement for at least 26 hours. The study drug was given as a bolus followed by a continuous infusion, and after 6 hours, a repeat bolus was given and the infusion was increased. Hemodynamic measures were obtained with the Swan-Ganz catheter at baseline prior to drug bolus, 1, 6, 7, and 24 hours during the infusion, and at 26 hours (2 hours after stopping the infusion). For each patient, the outcome was defined as the change from baseline. Means were compared using a repeated measures analysis of variance model.
Results Twenty children were included in the study, of which 9 were randomized to nesiritide and 11 to placebo. At 24 hours, the mean change in PCWP from baseline was -5.3 mmHg for nesiritide and +1.2 mmHg for placebo (p=0.02). At 6, 24 and 26 hours, the mean change in SBP for nesiritide was significantly greater than for placebo (-13.4 vs. -1.3 mmHg, p=0.02, -7.9 vs. +2.6 mmHg, p=0.04, and -11.0 mmHg vs. -0.8 mmHg, p=0.045). At 7 and 24 hours, the mean change in mean pulmonary artery pressure (MPAP) was significantly greater for nesiritide than for placebo (-5.8 vs. =1.1 mmHg, p=0.02 and -8.0 vs. +0.3 mmHg, p=0.006). There was no significant difference in RAP and CI between groups. There were no serious complications such as severe hypotension or arrhythmias.
Conclusions Nesiritide significantly decreases PCWP, SBP, and MPAP. Nesiritide is safe and effective in the acute management of children with decompensated heart failure.