RESUMO
BACKGROUND: It was reported previously that 30 min administration of adrenomedullin (AM) improves hemodynamics in chronic stable heart failure patients. The present study was designed to examine whether long-term AM + human atrial natriuretic peptide (hANP) administration can be used as a therapeutic drug in patients with acute decompensated heart failure (ADHF) in clinical setting. METHODS AND RESULTS: Seven acute heart failure patients (74 +/- 5 years) with dyspnea and pulmonary congestion were studied. AM (0.02 microg x kg(-1) x min(-1)) + hANP (0.05 microg x kg(-1) x min(-1)) was infused for 12 h and then hANP (0.05 microg x kg(-1) x min(-1)) was infused for 12 h. Hemodynamic, renal, hormonal and oxidative stress responses were evaluated. AM + hANP significantly reduced mean arterial pressure, pulmonary arterial pressure and systemic and pulmonary vascular resistance without changing heart rate, and increased cardiac output for most time-points compared with those at baseline. In addition, AM + hANP reduced aldosterone, brain natriuretic peptide and free-radical metabolites compared with those at baseline (all P<0.05). AM + hANP increased urine volume and U(Na)V compared with baseline data. CONCLUSIONS: In this small, pilot trial, AM + hANP therapy had beneficial hemodynamic and hormonal effects in ADHF. Intravenous infusion of AM with hANP could be used as a therapeutic drug in ADHF. These data are preliminary and require confirmation in a larger clinical study.
Assuntos
Adrenomedulina/administração & dosagem , Fator Natriurético Atrial/administração & dosagem , Fármacos Cardiovasculares/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Doença Aguda , Adrenomedulina/sangue , Idoso , Fator Natriurético Atrial/sangue , Biomarcadores/sangue , Fármacos Cardiovasculares/sangue , Esquema de Medicação , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Rim/efeitos dos fármacos , Rim/fisiopatologia , Masculino , Estresse Oxidativo/efeitos dos fármacos , Projetos Piloto , Fatores de Tempo , Resultado do Tratamento , Urodinâmica/efeitos dos fármacosRESUMO
A 57-year-old man with nonischemic dilated cardiomyopathy and ventricular tachycardia underwent routine dual chamber implantable cardioverter defibrillator (ICD) implantation. An active-fixation atrial lead was positioned at the lateral wall of the right atrium. He subsequently developed chronic severe pericarditis. Histopathological findings of the pericardium showed mechanical stimulus localized pericarditis. This case demonstrates that contact of the screw of the active-fixation atrial lead with the pericardium may be a possible mechanism for pericarditis after pacemaker/ICD implantation.
