PURPOSE: Diastolic heart failure is defined as clinical heart failure with normal systolic function. The purpose of this study is to assess the effect of nesiritide on left ventricular diastolic function properities.
METHODS: This study has an uncontrolled experimental repeated measure design. Three transthoracic 2-D echocardiograms were performed on each of fourteen patients with decompenstaed diastolic heart failure: baseline, three and twenty four hours after initiation of intravenous nesiritide.
RESULTS: Baseline transthoracic 2-D echocardiogram identified nine patients as stage II (pseudonormal), three patients as stage III (restrictive), and two patients as stage I (impaired relaxation) diastolic dysfunction. Normally distributed data was analyzed by repeated measures ANOVA followed by Dunnett's post-hoc test comparing the three and twenty four hour parameters with the baseline parameters. Data that was not normally distributed, Freidman's test was applied followed by Dunn's test comparing the same groups. Mean IVRT (isovolumic relaxation time) was prolonged by 5.38 msec (95% CI 2.13–12.9,NS) at 3 hours and by 17.15 msec (95% CI 9.63–24.68, P<0.01) at 24 hours. The propagation velocity (Vp) had a statistically insignificant mean increase of 15.06 cm/sec (95% CI 6.38–36.5,NS)at 3 hours, and a statistically significant mean increase of 35.19 cm/sec (95% CI 13.74–56.63,P<0.01) at 24 hours. In addition, BNP (brain natriuretic peptide) decreased significantly (P=0.0034) at 24 hours. This is all consistent with improvement of diastolic left ventricular function.
CONCLUSION: These data showed that intravenous nesiritide exerts a favorable outcome on the intrinsic left ventricular diastolic function. After nesiritide infusion, the baseline moderate to severe stages of diastolic heart failure were changed to milder forms.
CLINICAL IMPLICATIONS: Patients with decompenstaed heart failure and normal systolic function can benefit from in-hospital nesiritide infusion. The length of in-hospital stay can be potentially reduced.
DISCLOSURE: Tareq Baghal, No Financial Disclosure Information; No Product/Research Disclosure Information