Pulmonary Vascular Disease: Student/Resident Case Report Poster - Pulmonary Vascular Disease I |

Revisiting Nesiritide (Natrecor) in Group 2 Pulmonary Hypertension FREE TO VIEW

Abdul Rahman, MD; Pratima Dibba, MD; Lukman Hassan, MD; Zaza Cohen, MD; Errol Williams, MD
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HackensackUMC Mountainside Hospital, Nutley, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1207A. doi:10.1016/j.chest.2016.08.1316
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SESSION TITLE: Student/Resident Case Report Poster - Pulmonary Vascular Disease I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Pulmonary hypertension (PH) due to left heart disease, classified as Group 2 PH, is the most common cause of PH, with significant morbidity and mortality. There is no specific treatment for Group 2 PH other than treatment of the underlying condition. This case study evaluates the use of nesiritide, a recombinant B-type natriuretic peptide (BNP) which is no longer indicated for the treatment for acute or chronic decompensated heart failure, as a drug for severe group 2 PH.

CASE PRESENTATION: This is a 64 year woman with past medical history of diastolic heart failure who was initially admitted to the intensive care unit (ICU) for hypoxemia, acute hypercapnia, and chest congestion with bilevel positive airway pressure (BiPAP) support. While patient was treated in the ICU and medical wards, patient still had complaints of dyspnea at rest, and despite attempts to optimize her BiPAP setting, remained dyspneic at rest, hypoxic with resting tachycardia, and continuously BiPAP dependent. She was initially treated diuretics and sildenafil with no response. Thereafter, patient was started on 0.01 mcg/kg/ml Nesiritide for 1 week as a continuous infusion. With Nesiritide treatments, patient was able to wean off BiPAP, became less dyspneic at rest, and had a dramatic improvement in arterial blood gases (ABG). Patient was followed outpatient at the heart failure center for biweekly treatments which consisted of IV nesiritide. Her initial ECHO demonstrated left ventricular hypertrophy with diastolic dysfunction, severe right ventricular dilatation, right ventricular hypokinesis, and PH estimated at 69.2 mmHg. Her follow up ECHO at 8 months revealed decrease in left ventricular enlargement, normalization of right ventricular size and function with no evidence of PH.

DISCUSSION: Treatment for group 2 PH usually consists of aggressive management of heart failure, nonspecific vasodilators, and treatment modalities for group 1 PH such as prostanoids, endothelin receptor antagonists, and PDE5 inhibitors. In spite the multitude of treatment modalities available, there is no sufficient evidence to support the use of these drugs. Given the vasodilatory, hemodynamic, and natriuretic properties of nesiritide, it may be beneficial in patients with severe grade 2 PH unresponsive to conventional medications.

CONCLUSIONS: In light of dramatic improvement as evidenced by the echocardiogram and clinical picture, nesiritide may have a beneficial role in treating severe group 2 pulmonary hypertension.

Reference #1: Vachiéry J, Adir Y, Barberà J, et al. Pulmonary Hypertension Due to Left Heart Diseases. J Am Coll Cardiol. 2013;62(25_S): doi:10.1016/j.jacc.2013.10.033.

Reference #2: Michaels A, Chatterjee K, & Marco T. Effects of Intravenous Nesiritide on Pulmonary Vascular Hemodynamics in Pulmonary Hypertension. Journal of Cardic Failure, 11(6), pp 425-431

DISCLOSURE: The following authors have nothing to disclose: Abdul Rahman, Pratima Dibba, Lukman Hassan, Zaza Cohen, Errol Williams

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