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
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Citações na Scopus
Tipo de produção
conferenceObject
Data de publicação
2012
Título da Revista
ISSN da Revista
Título do Volume
Editora
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
Autores
BRANCALHAO, Euler O.
VIERA, Kelly N.
Citação
JOURNAL OF CARDIAC FAILURE, v.18, n.8, suppl.1, p.S61-S61, 2012
Resumo
Objectives: The dual blockage of renin-angiotensin-aldosterone system could be useful for end-stage inotrope-dependent patients. The objective of this study was to evaluate the effects of angiotensin receptor blocker add-on therapy in low cardiac output in decompensated heart failure. Methods: We selected patients hospitalized for decompensated heart failure with low cardiac output and dobutamine dependence, ejection fraction < 0.45, spontaneous breathing and receiving angiotensin-converting enzyme (ACE) inhibitor. They were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide (BNP) measurements at baseline and on the seventh day of intervention. Results: We studied 10 patients in losartan group and 11 patients in placebo group, the main characteristics were 52.7 years old, ejection fraction of 21.3%, dobutamine infusion of 8.5mcg/kg.min, indexed systemic vascular resistance of 1918.0 dynes.sec/cm5.m2, cardiac index of 2.8 L/min.m2, and BNP of 1,403 pg/mL. After 7 days of intervention, there was a reduction of 37.4% in BNP levels in the losartan group, compared with an increase of 11.9% in the placebo group (mean difference, -49.1%; 95% CI: -88.1 to -9.8%, P = 0.018). No significant difference was found in hemodynamic measurements. Conclusions: Short-term add-on therapy with losartan reduced BNP levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.