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Dr James Young Head, Section of Heart Failure and Cardiac Transplant Medicine

BNP for CHF. Dr James Young Head, Section of Heart Failure and Cardiac Transplant Medicine Cleveland Clinic Foundation Cleveland, OH. BNP for CHF. B-type natriuretic peptide. nesiritide (B-type natriuretic peptide)

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Dr James Young Head, Section of Heart Failure and Cardiac Transplant Medicine

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  1. BNP for CHF Dr James Young Head, Section of Heart Failure and Cardiac Transplant Medicine Cleveland Clinic Foundation Cleveland, OH

  2. BNP for CHF B-type natriuretic peptide • nesiritide (B-type natriuretic peptide) • Hormone produced by the left ventricle in response to increase in volume and pressure in the left ventricle. • A potent vasodilator, acts to counteract other hormones that are associated with heart failure.

  3. BNP for CHF VMAC trial Vasodilation in the Management of Acute CHF 498 patients in a multicenter (55 US sites) trial Randomization stratified by use of right heart catheter Placebo- and nitroglycerin-controlled

  4. BNP for CHF VMAC: design 3-hourplacebo-controlled period Active-controlledtreatment period randomization nitroglycerin (n=60) nitroglycerin (n=92) stratification catheterized(n=246) placebo (n=62) nesiritide fixed-dose (n=62) nesiritide fixed-dose (n=92) nesiritide adjustable-dose (n=62) nesiritide adjustable-dose (n=62) eligiblepatient(n=489) non- catheterized(n=243) nitroglycerin (n=124) nitroglycerin (n=83) placebo (n=80) nesiritide fixed-dose (n=80) nesiritide fixed-dose (n=119) 3 hours time zero end ofstudydrug 6 months Time

  5. BNP for CHF VMAC: findings Primary endpoint: PCWP through 3 hours NTG Nesiritide Placebo 30 29 28 27 26 25 #* 24 #* 23 # #* # 22 * 21 20 19 18 Time *p <0.05 versus placebo

  6. BNP for CHF Mortality VMAC not designed to answer mortality question No statistically significant difference at 30 day, 90 day, 150 day marks.

  7. BNP for CHF Costs Yet to be approved for general use as treatment by the FDA. Pharmacoeconomic studies have not been done. Hope to see it competitively priced with some of the inotropic agents used today. Added value possible if it aids treatment by keeping people out of ICU or out of hospital.

  8. BNP for CHF FDA approval Cardio-renal advisory panel of FDA voted 5-4 in January 1999 for the drug. VMAC was designed to answer some additional questions the FDA had.

  9. 3 of 4 BNP for CHF Specificity and sensitivity 100 patients presenting to the ER with signs or symptoms of congestive heart failure (eg,dyspnea,edema, weight gain) Dao and colleagues, 49th AnnualScientific Session ofthe American College of Cardiology

  10. 2 of 4 BNP for CHF Marker for CHF • BNP levels identified individuals with: • normal heart function (BNP = 38  4pg/mL) • normal ejection fraction but wallmotion abnormalities (BNP = 177  20 pg/mL) • impaired ejection fraction (BNP = 523  50 pg/mL,p<0.001) Koon and colleagues, 49th AnnualScientific Session ofthe American College of Cardiology

  11. BNP for CHF The future? • “I think it’s going to be an elegant way of being able to track patients with heart failure and seeing where exactly they are. It may become, if my hunch is right […] the complete blood count measurement to see where a patient is at with this heart failure syndrome at any given time.” Dr James Young Head, Section of Heart Failure and Cardiac Transplant Medicine Cleveland Clinic Foundation Cleveland, OH

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