Sodium Nitroprusside for Advanced Low-Output Heart Failure

Mullens, Wilfried; Abrahams, Zuheir; Francis, Gary S.; Skouri, Hadi; Starling, Randall C.; Young, James B.; Taylor, David O.; Tang, W.H. Wilson

doi:10.1016/j.jacc.2008.02.083

Cited by 191 publications

(128 citation statements)

References 39 publications

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“…In patients with passive PH, vasodilator therapy provided relief in filling pressures that was accompanied by an indirect increase in cardiac index, presumably through a reduction in left ventricular forward impedance and backward valvular regurgitation. 26 By contrast, in patients with reactive PH, the alleviation of increased filling pressures did not result in an improvement of cardiac index. Because RV systolic function is highly sensitive to changes in RV afterload, it is conceivable that the lack of PVR response to vasodilator therapy might worsen RV loading conditions, preventing improvement of cardiac index, and, if sustained, could ultimately lead to a decline in RV systolic performance.…”

Section: Ph and Clinical Outcomementioning

confidence: 94%

Relationship Between Reactive Pulmonary Hypertension and Mortality in Patients With Acute Decompensated Heart Failure

Aronson

Eitan

Dragu

et al. 2011

Circ: Heart Failure

128

123

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Background-In patients with heart failure, pulmonary hypertension (PH) predicts higher risk for morbidity and mortality.However, few data are available on the prognostic implications of reactive (precapillary) PH superimposed on passive (postcapillary) PH. Methods and Results-We performed a subgroup analysis of 242 patients with acute decompensated heart failure assigned to pulmonary artery catheter placement in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Patients were classified into 3 groups, using the final (posttreatment) hemodynamic measurements: (1) no PH (mean pulmonary artery pressure Յ25 mm Hg; (2) passive PH (mean pulmonary artery pressure Ͼ25, pulmonary capillary wedge pressure Ͼ15 mm Hg, and pulmonary vascular resistance Յ3 Wood units); and (3) reactive PH (mean pulmonary artery pressure Ͼ25, pulmonary capillary wedge pressure Ͼ15 mm Hg, and pulmonary vascular resistance Ͼ3 Wood units). Fifty-eight patients were classified as normal mean pulmonary artery pressure, 124 with passive PH and 60 with reactive PH. During follow-up of 6 months, 5 (8.6%), 27 (21.8%), and 29 (48.3%) deaths occurred in patients without PH, patients with passive PH, and with reactive PH, respectively (PϽ0.0001). After multivariable adjustments, reactive PH remained an independent predictor of death, with an adjusted hazard ratio of 4.8 compared with patients without PH, and 2.8 compared with patients with passive PH (95% confidence interval, 1.7 to 4.7, Pϭ0.0001). Similar results were obtained when reactive PH was defined on the basis of transpulmonary gradient. Conclusions-Reactive PH is common among patients with acute decompensated heart failure after initial diuretic and vasodilator therapy. The adverse outcome associated with PH is predominantly due to increased mortality rates in the subgroup of patients with reactive PH. (Circ Heart Fail. 2011;4:644-650.)

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Section: Ph and Clinical Outcomementioning

confidence: 94%

Relationship Between Reactive Pulmonary Hypertension and Mortality in Patients With Acute Decompensated Heart Failure

Aronson

Eitan

Dragu

et al. 2011

Circ: Heart Failure

128

123

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“…[766][767][768] Sodium nitroprusside is a balanced preload-reducing venodilator and afterload-reducing arteriodilator that also dilates the pulmonary vasculature. 769 Data demonstrating efficacy are limited, and invasive hemodynamic blood pressure monitoring (such as an arterial line) is typically required; in such cases, blood pressure and volume status should be monitored frequently. Nitroprusside has the potential for producing marked hypotension and is usually used in the intensive care setting as well; longer infusions of the drug have been rarely associated with thiocyanate toxicity, particularly in the setting of renal insufficiency.…”

Section: Diuretics In Hospitalized Patientsmentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of Heart Failure

et al. 2013

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“…It can help restore NO balance, 73,74 can modulate systemic hemodynamics in acute decompensated heart failure patients presenting with elevated blood pressure, [75][76][77] and provides seamless therapy spanning inpatient to outpatient care. 78 In-hospital initiation of H-ISDN has been associated with lower all-cause mortality 78 and improved hemodynamics, 79 suggesting a need for prospectively assessing this therapy in acute decompensated heart failure.…”

Section: Role In Acute Decompensated Heart Failurementioning

confidence: 99%