Nitroprusside in Critically Ill Patients with Left Ventricular Dysfunction and Aortic Stenosis

Khot, Umesh N.; Novaro, Gian M.; Popović, Zoran B.; Mills, Roger M.; Thomas, James D.; Tuzcu, E. Murat; Hammer, Donald; Nissen, Steven E.; Francis, Gary S.

doi:10.1056/nejmoa022021

Cited by 226 publications

(118 citation statements)

References 30 publications

(24 reference statements)

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“…While long-term medical management is clearly not appropriate, a recent study by Khot et al 16 has provided new insight into vasodilator therapy. Once widely viewed as contraindicated in patients with severe aortic stenosis out of fear that vasodilator therapy would precipitate acute decompensation, these investigators found that nitroprusside therapy actually improved indices of cardiac function in such patients.…”

Section: Managementmentioning

confidence: 99%

Aortic stenosis: Is it simply a degenerative process or an active atherosclerotic process?

Hughes¹,

Chahoud²,

Mehta³

2005

Clin Cardiol

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Aortic stenosis remains the most common cause of cardiac valve replacement in developed countries. The prevalence of this condition increases with age, and many of the risk factors for coronary artery disease also appear related to the development and progression of aortic stenosis. Recent studies also suggest a relationship between calcium and lipid accumulation in both coronary artery disease and aortic stenosis. Most important, there is growing evidence that aggressive treatment of coronary artery disease risk factors, particularly hyperlipidemia, may influence the progression of aortic stenosis. In this article the current literature is reviewed as it relates to vascular biology, pathogenesis of aortic valve disease, and current and newly emerging management approaches in the care of the patient with aortic stenosis.

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Section: Managementmentioning

confidence: 99%

Aortic stenosis: Is it simply a degenerative process or an active atherosclerotic process?

Hughes¹,

Chahoud²,

Mehta³

2005

Clin Cardiol

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“…Breidthardt showed that high-dose sublingual or transdermal nitrate on top of standard HF therapy was safe and accelerated cardiac recovery (20). In another study, it was found that IV nitrate improved cardiac function in patients with acute HF due to severe aortic stenosis (21), in which vasodilators are generally thought to be contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

Topuz¹,

Kaplan²

2018

Eur J Ther

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Objective: The aim of this study was to evaluate the potential of intravenous (IV) nitroglycerine (NTG) administration to accelerate the reduction of B-type natriuretic peptide (BNP) levels in patients with decompensated systolic heart failure (HF) and to evaluate its impact on follow-up events. Methods: A total of 165 patients with systolic HF who were hospitalized due to acute decompensation were enrolled into the current study. Study patients were divided into two groups. Patients who were receiving standard HF therapy (angiotensin-converting enzyme [ACE] or angiotensin receptor blocker [ARB], beta-blockers, loop diuretics, and anticoagulant or anti-aggregant agents for venous prophylaxis) were categorized as the standard HF therapy group (n=72), and patients receiving a standard dose of IV NTG in addition to standard HF therapy were categorized as the IV NTG group (n=93). BNP levels and blood gas analyses were measured at admission and after 48 h; all patients were followed up along the first month after discharge. Results: Serum BNP levels decreased in all patients after 48 h. The decreasing of BNP level was higher and the improvement of blood gas analysis was better in the IV NTG group than in the standard therapy group (1347.1±314.3 vs. 280.0±196.2 pg/mL for the IV NTG group and 1178.3±305.5 vs. 495.4±229.9 pg/mL for the standard therapy group; p<0.001). In the multi-logistic regression analysis, serum sodium at admission, BNP level at 48 h, and use of IV NTG were found as predictors of 30-day follow-up events. Conclusion:We have shown that IV NTG therapy in addition to standard HF therapy has a markedly better effect on lowering of plasma BNP levels, improves blood gas analyses, and may reduce follow-up events in patients with systolic HF.

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“…Moreover, data from our institution has previously demonstrated that aggressive afterload reduction with intravenous sodium nitroprusside improves hemodynamics parameters in critically ill patients with concomitant severe AS and LVSD (13). In context of AS, a substantial body of literature has focused on quantifying afterload as valvulo-arterial impedance (Zva) (systolic blood pressure + mean transaortic gradient/ stroke volume index), a metric which incorporates both systemic arterial compliance and valvular impedance to characterize global left ventricular (LV) afterload (14)(15)(16)(17).…”

Section: Editorialmentioning

confidence: 94%

Moderate aortic valve stenosis in patients with left ventricular systolic dysfunction—insights on prognosis and the potential role of early aortic valve replacement

Huded

Desai

2017

J. Thorac. Dis.

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Nitroprusside in Critically Ill Patients with Left Ventricular Dysfunction and Aortic Stenosis

Cited by 226 publications

References 30 publications

Aortic stenosis: Is it simply a degenerative process or an active atherosclerotic process?

Aortic stenosis: Is it simply a degenerative process or an active atherosclerotic process?

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

Moderate aortic valve stenosis in patients with left ventricular systolic dysfunction—insights on prognosis and the potential role of early aortic valve replacement

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