Review of Vasodilators in Acute Decompensated Heart Failure: The Old and the New

Carlson, Marjorie; Eckman, Peter

doi:10.1016/j.cardfail.2013.05.007

Cited by 31 publications

(28 citation statements)

References 95 publications

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“…Furthermore, immediate MSNA and CSNA responses to some central stimuli have been shown to correlate (30). An increase in CSNA following BNP infusion (as we observed in sheep) might explain why the human studies using nesiritide in acute heart failure have been disappointing (5). Plasma NE levels did not change significantly in the current study.…”

Section: Discussionmentioning

confidence: 38%

Low-dose B-type natriuretic peptide raises cardiac sympathetic nerve activity in sheep

Charles

Jardine

Rademaker

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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The reported effects of atrial natriuretic peptide (ANP) on sympathetic nerve activity (SNA) are variable, dependent on concomitant hemodynamic actions, and likely to be regionally differentiated. There are few reports of the effect of B-type natriuretic peptide (BNP) on SNA and none have measured cardiac SNA (CSNA) by direct microneurography. We measured the effects of low-dose ANP and BNP (2.4 pmol·kg(-1)·min(-1) infused for 120 min) on CSNA and hemodynamics in conscious sheep (n = 8). While there was a trend for mean arterial pressure and cardiac output to fall with both ANP and BNP, changes were not significant compared with vehicle control. However, BNP did significantly reduce systolic arterial (97 ± 4.2 vs. 107 ± 6.8 mmHg during control; P = 0.043) and pulse pressures (0.047) and increase heart rate (110 ± 6.7 vs. 96 ± 7.3 beats/min; P = 0.044). Trends for these hemodynamic parameters to change with ANP did not achieve statistical significance. ANP also had no significant effect on any CSNA parameters measured. In contrast, BNP induced a rise in both CSNA burst frequency (∼20 bursts/min higher than control, P = 0.011) and burst area (∼40% higher than control, P = 0.013). BNP-induced rises in burst incidence (bursts/100 beats), and burst area per 100 beats, however, were not significant. In conclusion, BNP infused at low doses that only had subtle effects on hemodynamics increased CSNA burst frequency and burst are per minute. This increase in CSNA may in large part be secondary to an increase in heart rate as CSNA burst incidence and burst area per 100 beats were not significantly increased. This study provides no evidence for inhibition of CSNA by natriuretic peptides.

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Section: Discussionmentioning

confidence: 38%

Low-dose B-type natriuretic peptide raises cardiac sympathetic nerve activity in sheep

Charles

Jardine

Rademaker

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Although the proportion was much smaller than that for the Valsalva maneuver, this finding indicates that both NTG administration and the Valsalva maneuver might affect cardiac performance via changes in afterload, heart rate and/or neurohormonal activation such as sympathetic tone [16]. Therefore, the effects and pitfalls of the two preload-lowering methods should be considered by physicians in the assessment of diastolic function.…”

Section: Discussionmentioning

confidence: 99%

“…Because the Valsalva maneuver can influence cardiac autonomic function [14,15,20], it might be, at least in part, associated with the distinct features of changes in diastolic functional parameters of the maneuver compared to those of NTG. (3) NTG also induces its own hemodynamic changes other than preload alterations [16]. In addition, the drug has a longer-lasting effect than the Valsalva maneuver, which essentially involves a short-lived event (strain phase) and is likely to have shorter preload-reducing effects.…”

Section: Discussionmentioning

confidence: 99%

The Valsalva Maneuver Can Misdiagnose ‘Normal' as ‘Pseudonormal': A Word of Caution for an Echocardiographic Evaluation of Diastolic Function

Moon

Yoon²,

Choi³

et al. 2014

Cardiology

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Objectives: To identify differences in cardiac hemodynamic changes between the Valsalva maneuver and nitroglycerin (NTG) administration. Methods: Fifty-three subjects (37 men, 43 ± 12 years) with normal cardiac function [left ventricular ejection fraction ≥55%, early to late mitral inflow velocity ratio (E/A) ≥1, left atrial volume index ≤34 ml/m² and early diastolic mitral annulus velocity (E') ≥8 cm/s] were enrolled. Doppler parameters were determined at rest, during the Valsalva maneuver and after NTG administration. Results: Decreased E, A and E/A were observed both during the Valsalva maneuver and after NTG administration (p < 0.0001 for all). However, the reduction in E (ΔE_Valsalva: -30 ± 16 cm/s vs. ΔE_NTG: -17 ± 17 cm/s) and E/A (ΔE/A_Valsalva: -0.37 ± 0.28 vs. ΔE/A_NTG: -0.19 ± 0.25) and the prolongation of the deceleration time (DT) of E (ΔDT_Valsalva: 105 ± 74 ms vs. ΔDT_NTG: 83 ± 63 ms) were more prominent during the Valsalva maneuver than with NTG administration (p < 0.0001 for all). Particularly, a greater decrease in E' was observed during the Valsalva maneuver (ΔE'_Valsalva: -3 ± 2 cm/s vs. ΔE'_NTG: -2 ± 2 cm/s, p < 0.0001). Eighteen subjects (34%) showed ΔE/A ≥0.5 during the Valsalva maneuver; thus, they were mislabeled as ‘pseudonormal', while only 3 subjects (6%) showed ΔE/A ≥0.5 after NTG administration. Conclusions: The Valsalva maneuver not only decreases preload but also affects myocardial performance, thus, its use can result in the mislabeling of normal subjects as pseudonormal.

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“…Nitroglycerin, another antihypertensive drug, primarily dilates veins, causing blood accumulation in the peripheral vasculature, with less blood ultimately returning to the ventricles, thereby reducing cardiac preload. It can also dilate the peripheral arteries to reduce cardiac afterload 25 . However, both drugs can induce tachycardia and increase myocardial oxygen consumption.…”

mentioning

confidence: 99%

“…Esmolol is an ultrashort-acting β-adrenoceptor blocker, which can reduce the heart rate, prolong coronary perfusion, and increase subendocardial blood flow [26][27][28][29][30] . Vasoactive therapeutic agents such as combinations of esmolol with nicardipine or nitroglycerin are often used to maintain hemodynamic stability and associated with a decrease in stress responses in the perioperative period [24][25][26][27][28][29][30] . However, it remains unclear whether the combined use of esmolol with either nicardipine or nitroglycerin to maintain hemodynamic stability affects the incidence of POCD in elderly patients after surgery.…”

mentioning

confidence: 99%

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Sun¹,

Yang²,

Sun³

et al. 2017

Afr H. Sci.

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Objective: To investigate the effect of continuous intravenous injection of nicardipine and/or nitroglycerin with or without esmolol on the occurrence of early post-operative cognitive dysfunction (POCD) in elderly patients. Methods: Elderly patients (n=340) who underwent radiofrequency ablation for atrial fibrillation were randomized into five groups: A, nicardipine; B nicardipine+esmolol; C, (nitroglycerin) group; D nitroglycerin+esmolol; E (control) groups. The hemodynamic parameters were recorded, and Mini Mental State Examination was used to assess cognitive function. Results: At 30 min and 60 minutes after anesthesia and at the conclusion of surgery, the rate pressure product value was significantly lower in Groups B (10621.1±321.7, 10544.2±321.8, and 10701.3±325.5, respectively) and D (10807.4±351.1, 10784.3±360.3, and 10771.7±345.7, respectively) than in Group E (13217.1±377.6, 13203.5±357.3, and 13119.2±379.5, respectively). The heart rate was significantly higher in Groups A (104.1±10.3, 104.9±11.1, and 103.9±11.8, respectively) and C (103.7±11.3, 105.5±10.5, and 107.7±11.7, respectively) than in Group E (89.3±12.0, 88.5±11.5, and 85.5±11.6, respectively). The incidence of POCD was significantly lower in Groups A and B than in Groups C, D, and E. Univariate regression analysis showed that regimens in Groups A, B, and E and doses of propofol and fentanyl were risk factors for POCD. Multivariate logistic regression analysis revealed significant associations between the incidence of POCD and interventions in Groups A and B. Conclusion: Maintenance of stable intraoperative hemodynamics using nicardipine and nitroglycerin or their combinations with esmolol, especially nicardipine with esmolol, reduced the incidence of POCD in the elderly with potential cardiovascular diseases. Afri Health Sci2016;16(4): 1056-1066

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Review of Vasodilators in Acute Decompensated Heart Failure: The Old and the New

Cited by 31 publications

References 95 publications

Low-dose B-type natriuretic peptide raises cardiac sympathetic nerve activity in sheep

Low-dose B-type natriuretic peptide raises cardiac sympathetic nerve activity in sheep

The Valsalva Maneuver Can Misdiagnose ‘Normal' as ‘Pseudonormal': A Word of Caution for an Echocardiographic Evaluation of Diastolic Function

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

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