Abstract 2421: Differential Effects of Nesiritide versus Nitroglycerin on Inflammatory Biomarkers in Patients with Acute Decompensated Heart Failure
Inflammatory activation is seen with acute decompensated failure (ADHF) and has prognostic significance; however the effects of various treatments for ADHF have not been well studied. The purpose of the present study is to evaluate the differential response of inflammatory markers to nitroglycerin (NTG) vs. nesiritide (NES) treatment in ADHF. Patients were prospectively randomized within 24 hours of hospital admission to either NES (0.01 mcg/kg/min with or without a 2 mcg/kg bolus) or NTG (mean maximal dose 132 mcg/min) using a standard dosing protocol based on blood pressure monitoring. The inflammatory biomarkers, high sensitivity C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-α), transforming growth factor beta-1 (TGF-β), and interleukin-6 (IL-6),were evaluated at baseline and during infusion at 24 and 48 hours. The plasma concentrations of these markers were determined using a validated ELISA assay. Eighty-nine ADHF patients (54% male, mean age 68 years, mean LVEF 32%, 10% NYHA II, 28% III, 58% IV, mean SBP 133/75 mm Hg, mean baseline BNP 1695) were enrolled (44 NTG, 45 NES). Mean baseline values were not significicantly different between NTG and NES (1.3 vs. 1.3 mg/dL for serum creatiine, 135 vs. 130 mm Hg for systolic BP, and 51mg vs. 51 mg/day of IV furosemide). All 4 inflammatory markers were elevated in our ADHF patients and their response to NES or NTG infusion are shown in the table⇓ below. All patients survived the acute episode of ADHF and were discharged from the hospital with no significant changes in creatinine. NES significant reduced IL-6 and hsCRP levels in comparison to NTG. Conversely, TNF-α and TGF-β did not change significantly with either therapy. The differential effects of NES vs NTG on these inflammatory markers during ADHF may have important implications and should be the basis for further research.