Use Of Carperitide Research Articles

Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients.

The absence of high quality, large-scale data that indicates definitive mortality benefits does not allow for firm conclusions on the role of intravenous vasodilators in acute heart failure. We aimed to investigate the associations between intravenous vasodilators and clinical outcomes in acute heart failure patients, with a specific focus on patient profiles and type of vasodilators. Data of 26,212 consecutive patients urgently hospitalised for a primary diagnosis of acute heart failure between 2009 and 2015 were extracted from a government-funded multicentre data registration system. Propensity scores were calculated with multiple imputations and 1:1 matching performed between patients with and without vasodilator use. The primary endpoint was inhospital mortality. On direct comparison of the vasodilator and non-vasodilator groups after propensity score matching, there were no significant differences in the inhospital mortality rates (7.5% vs. 8.8%, respectively; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. In acute heart failure patients, vasodilator use was not universally associated with improved inhospital outcomes; rather, its effect depended on individual clinical presentation: patients with higher systolic blood pressure and no atrial fibrillation seemed to benefit maximally from vasodilators. UMIN-CTR identifier, UMIN000013128.

Effect of intravenous carperitide versus nitrates as first-line vasodilators on in-hospital outcomes in hospitalized patients with acute heart failure: Insight from a nationwide claim-based database

BackgroundsCarperitide is a recombinantly produced intravenous formulation of human atrial natriuretic peptide. Despite of negative impacts of nesiritide on clinical outcomes for acute heart failure (AHF), carperitide has been used for around a half of Japanese AHF patients as a vasodilator based on limited evidences. We sought to determine the effect of carperitide compared to nitrates in the early care for AHF patients treated with vasodilators. Methods and resultsWe conducted a cohort study of patients admitted with AHF to 808 hospitals from April 2012 to March 2014. Patients were extracted from 1,422,703 hospitalizations according to ICD-10 heart failure codes. Patients who had sepsis or mechanical supports during hospitalization were excluded. Outcomes were in-hospital death, length of hospitalization and cost of hospitalization. Among 76,924 patients, 45,595 were in patients treated with either carperitide or nitrates during the first 2 days (carperitide; 33,386, nitrates; 12,209). After application of inverse probability of treatment weighting with variables including demographics, comorbidities and treatments, there was perfect balance in both groups. Patients who were treated with carperitide had substantially higher covariate adjusted in-hospital mortality (HR 1.49 95%CI 1.35–1.64), longer length of hospitalization (Coefficients 0.062 95%CI 0.048 to 0.076) and greater cost of hospitalization (Coefficients 0.024 95%CI 0.010 to 0.037) compared to those treated with nitrates. ConclusionsIn Japanese AHF patients during their early inpatient care, carperitide use was significantly associated with worse outcomes when compared to nitrates use, suggesting the routine use of carperitide might not be recommended as a first-line vasodilator for AHF.

Suppression of Graft Spasm by the Particulate Guanylyl Cyclase Activator in Coronary Bypass Surgery

Spasm of arterial grafts is still a clinical problem in coronary artery bypass surgery. The present study was designed to examine the effect of particulate guanylyl cyclase activator (carperitide) as an antispastic agent in internal thoracic artery and gastroepiploic artery grafts. Isolated arterial grafts taken during surgery were studied in organ bath in three ways: the relaxing effect of carperitide on vasoconstrictor-induced precontraction; the inhibitory effect of pretreatment with carperitide on subsequent vasoconstrictor-induced contraction; and the effect of carperitide and nitroglycerin on increase of intracellular cyclic guanosine monophosphate levels. Carperitide produced a concentration-related, endothelium-independent relaxation contracted with potassium chloride, phenylephrine, prostaglandin F2α, or endothelin-1. Carperitide showed significantly higher potency and efficacy than nitroglycerin and nifedipine. Pretreatment with carperitide significantly attenuated the subsequent vasoconstrictor-induced contraction. Carperitide produced more cyclic guanosine monophosphate than nitroglycerin. Carperitide has a potent inhibitory effect on the vasoconstriction mediated by different vasoconstrictors in human internal thoracic artery and gastroepiploic artery grafts. The use of carperitide in patients during and after coronary artery bypass surgery is favored for the prevention and reversal of graft spasm.

Carperitide Increases the Need for Renal Replacement Therapy After Cardiovascular Surgery.

Acute kidney injury is a common complication after aortic surgery. Carperitide, a human atrial natriuretic peptide, was reported to be effective for preventing acute kidney injury after cardiac surgery. However, most studies were from single centers, and results of meta-analyses are subject to publication bias. The aim of the present study was to investigate whether carperitide preserved renal function in patients undergoing cardiovascular surgery. Retrospective cohort study. Participating hospitals (N = 281) in a national database from 2010 to 2013. Adult patients (N = 47,032) who underwent cardiovascular surgery. None. The main intervention variable investigated was the use of carperitide on the day of surgery. Assessed outcomes included receiving renal replacement therapy within 21 days of surgery and in-hospital mortality. Data were available for 47,032 patients, of whom 2,186 (4.6%) received carperitide on the day of surgery. Multivariate logistic regression analysis revealed that carperitide was significantly associated with a greater likelihood of receiving renal replacement therapy within 21 days of surgery, but not with in-hospital mortality. In patients undergoing cardiovascular surgery, carperitide significantly increased the odds of receiving renal replacement therapy within 21 days after surgery.

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Objectives In addition to blood pressure control, postpartum control of urine output is a major issue in hypertensive pregnancy, HELLP syndrome or placental abruption. Delayed diuresis after delivery may easily cause abdominal dropsy, pulmonary edema, or late-onset renal failure. We recently added a new medicine, carperitide (atrial natriuretic peptide, hANP®), in addition to standard diuretic, like furosemide, for diuresis in such severe postpartum conditions. The objective of this study was to reveal the clinical and cost effectiveness of use carperitide in postpartum intensive care after preeclampsia. Methods Medical records of the patients who were administered carperitide in Nara Medical University Hospital after delivery or cesarean section for severe preeclampsia, HELLP syndrome and placental abruption were reviewed. Six patients who used carperitide were compared with ten patients who did not. Duration between delivery or administration of carperitide and maternal massive diuresis were retrieved as well as background, maternal outcome, duration of stay in hospital and blood pressure. Results There have been no maternal deaths or the need for artificial dialysis after these diseases for recent five years. Use of carperitide significantly decreased maternal mean blood pressure after 48 h of operation and shortened the duration between delivery or cesarean section and massive diuresis. No adverse effect was defined. Conclusions Though it was not a randomized, controlled study, in the intensive care setting, use of carperitide in infusion-and-output control after preeclampsia and related severe diseases was associated with improved kidney protection, shortened duration of intensive care and hospitalization with fewer side effects. In difficulty of hydration control after preeclampsia, carperitide may be a useful medicine for intensive maternal care. Disclosures A. Shigemitsu: None. J. Akasaka: None. H. Shigetomi: None. T. Tsunemi: None. N. Koike: None. K. Iwai: None. K. Naruse: None. H. Kobayashi: None.

Characteristics, management, and outcomes for patients during hospitalization due to worsening heart failure—A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)

BackgroundThe characteristics, in-hospital management, and outcomes of patients hospitalized with worsening heart failure (HF) have been described by large-scale registries performed mainly in the USA and Europe. However, little information is available in Japan. We thus clarified the characteristics and clinical status as well as in-hospital management and outcomes among patients hospitalized with worsening HF in Japan and compared them with those reported in previous studies. MethodsThe Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) studied prospectively the characteristics and treatments in patients hospitalized with worsening HF. From the total cohort of JCARE-CARD, 1677 patients were randomly selected and their detailed data during acute phase were collected as another registry database in the present study. The characteristics, in-hospital management, and outcomes were analyzed. ResultsThe mean age was 70.7 years and 59.4% were male. Etiology was ischemic in 34.0% and mean left ventricular ejection fraction was 42.5%. Carperitide was highly used as in-hospital management in Japan (33.5%) compared to the use of nesiritide in the USA (8–11%). The use of angiotensin-converting enzyme inhibitors was lower and angiotensin II receptor blockers (ARB) were more commonly used in this study compared to other studies in the USA and Europe. In-hospital crude mortality rate was comparable among studies (4–8%), however, length of stay was longer in Japan (15–20 versus 4–9 days). ConclusionsThe characteristics, clinical status, and laboratory data on admission in patients hospitalized with worsening HF were similar between the present study and previous Japanese and western studies. Management was also similar except for higher use of carperitide and ARB. The most striking difference between Japanese registries and those from the USA and Europe was the longer length of stay.

Use of carperitide infusion for acutely decompensated heart failure

Mitaka and colleagues [1] recently reported in their meta-analysis that carperitide infusion improved the renal function of cardiovascular surgical patients, and we feel that this notion could be expanded to medical patients, particularly with the use of carperitide. Although some studies have not been able to recommend the use of nesiritide in acute heart failure (HF) patients [2,3], more recent clinical trials have demonstrated a favorable eff ect of carperitide on ventricular remodeling and neurohormonal systems [4,5]. In our own series of acute HF patients (N = 371), carperitide was given to 135 patients (36.4%) and it was more frequently used in patients with higher New York Heart Association functional class (30.4 versus 15.7%, P < 0.01), prominent signs of HF, such as S3 heart sound (65.4 versus 50.9%, P < 0.01), pulmonary rales (67.2 versus 31.3%, P < 0.01), jugular venous distention (49.6 versus 34.7%, P < 0.01), and lower extremity edema (64.1 versus 48.2%, P < 0.01). In agreement with the analysis performed by Mitaka and colleagues, patients on carperitide had a higher rate of improvement in functional class (96.0 versus 67.9%, P < 0.01) during the hospital course. Importantly, there was no worsening of the mortality and/or HF rehospitalization rate in the carperitide treatment group compared to the non-carperitide group (29.1 versus 25.4%, P = 0.29) during the mean follow-up period of 1.7 years. Further, the use of carperitide was not associated with adverse events after adjustment for known predictors of HF, such as hypertension, diabetes, hyperlipidemia, chronic kidney disease, and brain natriuretic peptide level at discharge (hazard ratio 1.13; P = 0.59). Carperitide compares favorably to nesiritide in several ways; it has a shorter half-life (2 minutes), does not mandate bolus infusion, and is used mostly as a single agent, not as an add-on drug to diuretics. We thus surmise that these unique pharmacological profi les may lead to diff erent outcomes and the use of carperitide should be judiciously evaluated in prospective trials.

Use of carperitide in patients admitted with acutely decompensated heart failure in Japan

Use of carperitide in patients admitted with acutely decompensated heart failure in Japan

Use of Carperitide in Patients Admitted with Acutely Decompensated Heart Failure in Japan

Use of Carperitide in Patients Admitted with Acutely Decompensated Heart Failure in Japan