Modulation of novel cardiorenal and inflammatory biomarkers by intravenous nitroglycerin and nesiritide in acute decompensated heart failure: an exploratory study

Circ Heart Fail. 2011 Jul;4(4):450-5. doi: 10.1161/CIRCHEARTFAILURE.110.958066. Epub 2011 May 16.

Abstract

Background: Modulation of novel cardiorenal and inflammatory markers may provide insight into the disease process and outcomes of patients with acute decompensated heart failure.

Methods and results: In this open-labeled, prospective, randomized study, 89 patients received either nesiritide (NES) or nitroglycerin (NTG) infusion by standard protocol. The serum or plasma concentrations of cystatin-C and inflammatory markers (high-sensitivity C-reactive protein, tumor necrosis factor-α, transforming growth factor-β1, and interleukin-6) were measured in 66 patients with acute decompensated heart failure at baseline and during drug infusion. Mean baseline values for demographics were not significantly different between NTG and NES groups; however, baseline inflammatory markers were elevated on admission. In NES compared with NTG groups, lower cystatin-C (1449 versus 2739 ng/mL, P<0.05) and IL-6 (25 versus 50 pg/mL, P<0.05) were observed. There were no significant differences in concentrations of high-sensitivity C-reactive protein, tumor necrosis factor-α, and transforming growth factor-β1 between groups over time.

Conclusions: The differential modulation effects of cystatin-C and interleukin-6 but not other inflammatory markers, in response to NES compared with NTG therapy, may provide important implications for vasodilator therapy. Further studies are warranted to confirm these findings.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00842023.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Cystatin C / blood*
  • Female
  • Glomerular Filtration Rate / drug effects
  • Glomerular Filtration Rate / physiology
  • Heart Failure / blood*
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Infusions, Intravenous
  • Interleukin-6 / blood*
  • Kidney / drug effects
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Natriuretic Agents / pharmacology
  • Natriuretic Agents / therapeutic use
  • Natriuretic Peptide, Brain / pharmacology
  • Natriuretic Peptide, Brain / therapeutic use*
  • Nitroglycerin / pharmacology
  • Nitroglycerin / therapeutic use*
  • Prospective Studies
  • Retrospective Studies
  • Transforming Growth Factor beta1 / blood
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / blood
  • Vasodilator Agents / pharmacology
  • Vasodilator Agents / therapeutic use

Substances

  • Biomarkers
  • Cystatin C
  • Interleukin-6
  • Natriuretic Agents
  • Transforming Growth Factor beta1
  • Tumor Necrosis Factor-alpha
  • Vasodilator Agents
  • Natriuretic Peptide, Brain
  • C-Reactive Protein
  • Nitroglycerin

Associated data

  • ClinicalTrials.gov/NCT00842023