Abstract 13781: Urocortin-2 has Favorable Hemodynamic Effects in Acute Decompensated Heart Failure: Findings from the UNICORN Trial
Background: Urocortin-2 (Ucn2) showed favorable hemodynamic effects in stable systolic heart failure but its actions in acute decompensated heart failure (ADHF) are unknown. We describe findings from the first therapeutic trial of Ucn2 infusion in ADHF with invasive hemodynamic monitoring.
Methods: Fifty three ADHF patients (66 +/- 2 years, LVEF 38 +/- 3%) were enrolled within 36hrs of hospitalization and randomized in 1:1 fashion to Ucn2 (5ng/kg/min) or placebo infusion for four hours as an adjunct to conventional therapy. Twenty patients (Ucn2=10, Placebo=10) had Swan-Ganz catheter measurements of right atrial pressure (RAP), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) monitoring and thermodilution cardiac output (CO). Blood pressure (BP) and heart rate (HR) were obtained non-invasively. Serial observations were made over eight hours.
Results: One subject required down-titration of Ucn2 due to hypotension (systolic BP <85 mmHg). Flushing was more commonly observed with Ucn2 (6 vs 2 patients). There were no arrhythmias or other significant adverse events during infusion. Ucn2 exerted a profound vasodilatory effect, peak systolic BP fall was greater for Ucn2 than placebo (23.4 ± 9.8mmHg vs 5.2 ± 10.8mmHg, p<0.001). CO increased significantly during Ucn2 infusion (2.1 ± 0.4L/min vs -0.1 ± 0.4L/min, p<0.001; Figure).There was a greater reduction in calculated total peripheral resistance for UCN2 than placebo (47% vs 21% p=0.015). These was no significant increase in HR, peak increase 4 ± 5bpm (Ucn2) vs 2 ± 5bpm (placebo) p=0.88. RAP, PAP and PCWP fell to a similar extent in both treatment arms.
Conclusion: Ucn2 infusion was associated with significant reductions in systemic BP and increases in CO without significant increases in HR. These beneficial hemodynamic effects suggest that Ucn2 could have therapeutic potential in ADHF and warrants further investigation.
- © 2012 by American Heart Association, Inc.