Advertisement

Click here for more guidelines.
2012 ACCF/ AATS/ SCAI/ STS Expert Consensus Document on Transcatheter Aortic Valve Replacement
ACCF/ SCAI/ STS/ AATS/ AHA/ ASNC/ HFSA/ SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update
2012 ACCF/ AHA/ ACR/ SCAI/ SIR/ STS/ SVM/ SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

 
About JACC CME
Policy on Privacy and Confidentiality
Disclosures
Important Information
 

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME
 
 

Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions
 
 

About the Journal
Editorial Board & Staff
 
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2007; 49:716-726, doi:10.1016/j.jacc.2006.10.048 (Published online 8 December 2006).
© 2007 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View NAPA Investigators
Right arrow All Versions of this Article:
j.jacc.2006.10.048v1
49/6/716    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (82)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mentzer, R. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mentzer, R. M., Jr
Related Collections
Right arrowRelated Article

EXPEDITED REVIEW

Effects of Perioperative Nesiritide in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery

The NAPA Trial

Robert M. Mentzer, Jr, MD, FACC*,*, Mehmet C. Oz, MD, FACC{dagger}, Robert N. Sladen, MD, FCCM{ddagger}, Allen H. Graeve, MD, FACS§, Robert F. Hebeler, Jr, MD||, John M. Luber, Jr, MD, FACS, Nicholas G. Smedira, MD, FACC# on behalf of the NAPA Investigators

* Division of Cardiothoracic Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
{dagger} Division of Cardiothoracic Surgery, College of Physicians & Surgeons, Columbia University, New York, New York
{ddagger} Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, New York
§ MultiCare Cardiothoracic Surgical Associates, Tacoma General Hospital, Tacoma, Washington
|| Department of Surgery, Baylor University Medical Center, Dallas, Texas
Franciscan Health System Research Center, Tacoma, Washington
# Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, Ohio.

Manuscript received August 1, 2006; revised manuscript received September 26, 2006, accepted October 12, 2006.

* Reprint requests and correspondence: Dr. Robert M. Mentzer, Jr., Wayne State University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, 1241 Scott Hall, 540 E. Canfield, Detroit, Michigan 48201. (Email: rmentzer{at}med.wayne.edu).

Objectives: The purpose of this study was to determine the role nesiritide might play in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).

Background: Given the hemodynamic, neurohormonal, and renal effects of natriuretic peptides, nesiritide might be useful in the management of patients undergoing cardiac surgery.

Methods: This prospective, double-blind, exploratory evaluation randomly assigned patients with ejection fraction ≤40% who were undergoing CABG with anticipated use of CPB to receive either nesiritide or placebo, in addition to usual care, for 24 to 96 h after induction of anesthesia. Postoperative renal function, hemodynamics, and drug use (primary end points) were assessed in patients who underwent CABG using CPB; mortality and safety (secondary end points) were assessed in all patients who received the study drug.

Results: Of 303 randomized patients, 279 received the study drug and 272 underwent CABG using CPB. Compared with placebo, nesiritide was associated with a significantly attenuated peak increase in serum creatinine (0.15 ± 0.29 mg/dl vs. 0.34 ± 0.48 mg/dl; p < 0.001) and a smaller fall in glomerular filtration rate (–10.8 ± 19.3 ml/min/1.73 m2 vs. –17.2 ± 21.9 ml/min/1.73 m2; p = 0.001) during hospital stay or by study day 14, and a greater urine output (2,926 ± 1,179 ml vs. 2,350 ± 1,066 ml; p < 0.001) during the initial 24 h after surgery. In addition, nesiritide-treated patients had a shorter hospital stay (p = 0.043) and lower 180-day mortality (p = 0.046).

Conclusions: Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhanced survival. (The NAPA Trial; http://www.clinicaltrials.gov/ct/show; NCT00090792 [ClinicalTrials.gov] )

Abbreviations and Acronyms
  CABG = coronary artery bypass grafting
  CI = confidence interval
  CPB = cardiopulmonary bypass
  GFR = glomerular filtration rate
  HR = hazard ratio
  ICU = intensive care unit
  LOS = length of stay
  LV = left ventricular
  SCr = serum creatinine


Related Article

Nesiritide Administration in Patients With Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery
Israel Belenkie
J. Am. Coll. Cardiol. 2007 49: 727-728. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 J CARDIOVASC PHARMACOL THERHome page
T. M. H. Ng, K. A. Ackerbauer, A. F. Hyderi, S. Hshieh, and U. Elkayam
Comparative Effects of Nesiritide and Nitroglycerin on Renal Function, and Incidence of Renal Injury by Traditional and RIFLE Criteria in Acute Heart Failure
Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2012; 17(1): 79 - 85.
[Abstract] [PDF]

Home page
 J Am Coll CardiolHome page
A. Sezai, M. Hata, T. Niino, I. Yoshitake, S. Unosawa, S. Wakui, H. Kimura, M. Shiono, T. Takayama, and A. Hirayama
Results of Low-Dose Human Atrial Natriuretic Peptide Infusion in Nondialysis Patients With Chronic Kidney Disease Undergoing Coronary Artery Bypass Grafting: The NU-HIT (Nihon University Working Group Study of Low-Dose hANP Infusion Therapy During Cardiac Surgery) Trial for CKD
J. Am. Coll. Cardiol., August 23, 2011; 58(9): 897 - 903.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. Boerrigter and J. C. Burnett Jr
Natriuretic Peptides: Renal Protective After All?
J. Am. Coll. Cardiol., August 23, 2011; 58(9): 904 - 906.
[Full Text] [PDF]

Home page
 J Intensive Care MedHome page
J. D. Tobias
B-type Natriuretic Peptide: Diagnostic and Therapeutic Applications in Infants and Children
J Intensive Care Med, May 1, 2011; 26(3): 183 - 195.
[Abstract] [PDF]

Home page
 J Am Coll CardiolHome page
P. A. McCullough, M. El-Ghoroury, and H. Yamasaki
Early Detection of Acute Kidney Injury With Neutrophil Gelatinase-Associated Lipocalin
J. Am. Coll. Cardiol., April 26, 2011; 57(17): 1762 - 1764.
[Full Text] [PDF]

Home page
 CirculationHome page
T. Ichiki and J. C. Burnett Jr
A New Signal From B-Type Natriuretic Peptide in ST-Elevation Myocardial Infarction: What Does It Mean for B-Type Natriuretic Peptide and Innovative Diagnostics?
Circulation, July 20, 2010; 122(3): 229 - 232.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
L. Brochard, F. Abroug, M. Brenner, A. F. Broccard, R. L. Danner, M. Ferrer, F. Laghi, S. Magder, L. Papazian, P. Pelosi, et al.
An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: An International Consensus Conference in Intensive Care Medicine
Am. J. Respir. Crit. Care Med., May 15, 2010; 181(10): 1128 - 1155.
[Abstract] [Full Text] [PDF]

Home page
 Circ Heart FailHome page
L. C. Costello-Boerrigter, G. Boerrigter, A. Cataliotti, G. J. Harty, and J. C. Burnett Jr
Renal and Anti-Aldosterone Actions of Vasopressin-2 Receptor Antagonism and B-Type Natriuretic Peptide in Experimental Heart Failure
Circ Heart Fail, May 1, 2010; 3(3): 412 - 419.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. Sezai, M. Hata, T. Niino, I. Yoshitake, S. Unosawa, S. Wakui, K. Fujita, T. Takayama, Y. Kasamaki, A. Hirayama, et al.
Continuous Low-Dose Infusion of Human Atrial Natriuretic Peptide in Patients With Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Grafting: The NU-HIT (Nihon University working group study of low-dose Human ANP Infusion Therapy during cardiac surgery) for Left Ventricular Dysfunction
J. Am. Coll. Cardiol., April 27, 2010; 55(17): 1844 - 1851.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. A. Voors and D. J. van Veldhuisen
Cardiorenal Effects of Recombinant Human Natriuretic Peptides
J. Am. Coll. Cardiol., April 27, 2010; 55(17): 1852 - 1853.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
C. Ronco, P. McCullough, S. D. Anker, I. Anand, N. Aspromonte, S. M. Bagshaw, R. Bellomo, T. Berl, I. Bobek, D. N. Cruz, et al.
Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative
Eur. Heart J., March 2, 2010; 31(6): 703 - 711.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. A. Ejaz, T. D. Martin, R. J. Johnson, A. G. Winterstein, C. T. Klodell, P. J. Hess Jr., A. K. Ali, E. M. Whidden, N. L. Staples, J. A. Alexander, et al.
Prophylactic nesiritide does not prevent dialysis or all-cause mortality in patients undergoing high-risk cardiac surgery
J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 959 - 964.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. Sezai, M. Hata, T. Niino, I. Yoshitake, S. Unosawa, S. Wakui, S. Osaka, T. Takayama, Y. Kasamaki, A. Hirayama, et al.
Influence of Continuous Infusion of Low-Dose Human Atrial Natriuretic Peptide on Renal Function During Cardiac Surgery: A Randomized Controlled Study
J. Am. Coll. Cardiol., September 15, 2009; 54(12): 1058 - 1064.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
A M. Richards
Therapeutic potential of infused cardiac natriuretic peptides in myocardial infarction
Heart, August 15, 2009; 95(16): 1299 - 1300.
[Full Text] [PDF]

Home page
 Am. J. Physiol. Heart Circ. Physiol.Home page
I. George, B. Morrow, K. Xu, G.-H. Yi, J. Holmes, E. X. Wu, Z. Li, A. A. Protter, M. C. Oz, and J. Wang
Prolonged effects of B-type natriuretic peptide infusion on cardiac remodeling after sustained myocardial injury
Am J Physiol Heart Circ Physiol, August 1, 2009; 297(2): H708 - H717.
[Abstract] [Full Text] [PDF]

Home page
 J Clin PharmacolHome page
C. Y. W. Lee, H. H. Chen, O. Lisy, S. Swan, C. Cannon, H. D. Lieu, and J. C. Burnett Jr.
Pharmacodynamics of a Novel Designer Natriuretic Peptide, CD-NP, in a First-in-Human Clinical Trial in Healthy Subjects
J. Clin. Pharmacol., June 1, 2009; 49(6): 668 - 673.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
H. H. Chen, A. Cataliotti, J. A. Schirger, F. L. Martin, L. K. Harstad, and J. C. Burnett Jr
Local Renal Delivery of a Natriuretic Peptide: A Renal-Enhancing Strategy for B-Type Natriuretic Peptide in Overt Experimental Heart Failure
J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1302 - 1308.
[Abstract] [Full Text] [PDF]

Home page
 Interact CardioVasc Thorac SurgHome page
J. Ambwani, D. Ubhrani, R. Saad, and J. Dunning
Could atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery?
Interact CardioVasc Thorac Surg, April 1, 2009; 8(4): 474 - 478.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
H. H. Chen
Atrial Natriuretic Peptide for the Prevention of Contrast-Induced Nephropathy: What's Old Is New But at the Right Dose and Duration of Therapy!
J. Am. Coll. Cardiol., March 24, 2009; 53(12): 1047 - 1049.
[Full Text] [PDF]

Home page
 Arch SurgHome page
M. J. Russo, A. Rana, J. M. Chen, K. N. Hong, A. Gelijns, A. Moskowitz, W. D. Widmann, L. Ratner, Y. Naka, and M. A. Hardy
Pretransplantation Patient Characteristics and Survival Following Combined Heart and Kidney Transplantation: An Analysis of the United Network for Organ Sharing Database
Arch Surg, March 1, 2009; 144(3): 241 - 246.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. I. Eriksson, J. R. Jalonen, L. O. Heikkinen, M. Kivikko, M. Laine, K. A. Leino, A. H. Kuitunen, K. T. Kuttila, T. K. Perakyla, T. Sarapohja, et al.
Levosimendan Facilitates Weaning From Cardiopulmonary Bypass in Patients Undergoing Coronary Artery Bypass Grafting With Impaired Left Ventricular Function
Ann. Thorac. Surg., February 1, 2009; 87(2): 448 - 454.
[Abstract] [Full Text] [PDF]

Home page
 Clin Kidney JHome page
N. Lameire, W. van Biesen, E. Hoste, and R. Vanholder
The prevention of acute kidney injury an in-depth narrative review: Part 2: Drugs in the prevention of acute kidney injury
Clinical Kidney Journal, February 1, 2009; 2(1): 1 - 10.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
U. Elkayam, M. W. Akhter, M. Liu, P. Hatamizadeh, and M. N. Barakat
Assessment of renal hemodynamic effects of nesiritide in patients with heart failure using intravascular Doppler and quantitative angiography.
J. Am. Coll. Cardiol. Img., November 1, 2008; 1(6): 765 - 771.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
C. McKown Dyke, D. Bhatia, S. Aronson, N. Moazami, and R. M. Mentzer Jr.
Perioperative nesiritide and possible renal protection in patients with moderate to severe kidney dysfunction.
J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1369 - 1370.
[Full Text] [PDF]

Home page
 CirculationHome page
A. Cataliotti, H. H. Chen, J. A. Schirger, F. L. Martin, G. Boerrigter, L. C. Costello-Boerrigter, K. D. James, K. Polowy, M. A. Miller, N. B. Malkar, et al.
Chronic Actions of a Novel Oral B-Type Natriuretic Peptide Conjugate in Normal Dogs and Acute Actions in Angiotensin II-Mediated Hypertension
Circulation, October 21, 2008; 118(17): 1729 - 1736.
[Abstract] [Full Text] [PDF]

Home page
 J Intensive Care MedHome page
A. Ryan, D. A. Rosen, and J. D. Tobias
Preliminary Experience With Nesiritide in Pediatric Patients Less Than 12 Months of Age
J Intensive Care Med, September 1, 2008; 23(5): 321 - 328.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. S. Stewart, M. J. Russo, T. P. Martens, T. M. Naseem, M. C. Deng, R. Wang, M. Argenziano, M. Oz, and Y. Naka
Longer duration of continuous-flow ventricular assist device support predicts greater hemodynamic compromise after return of pulsatility.
J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 524 - 525.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. R. Brown, R. P. Cochran, T. A. MacKenzie, A. P. Furnary, K. S. Kunzelman, C. S. Ross, C. W. Langner, D. C. Charlesworth, B. J. Leavitt, L. J. Dacey, et al.
Long-Term Survival After Cardiac Surgery is Predicted by Estimated Glomerular Filtration Rate
Ann. Thorac. Surg., July 1, 2008; 86(1): 4 - 11.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
O. Lisy, B. K. Huntley, D. J. McCormick, P. A. Kurlansky, and J. C. Burnett Jr
Design, Synthesis, and Actions of a Novel Chimeric Natriuretic Peptide: CD-NP
J. Am. Coll. Cardiol., July 1, 2008; 52(1): 60 - 68.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. M. Beaver, A. Bihorac, and A. A. Ejaz
Reply to the Editor:
J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 233 - 233.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
J. C. Burnett Jr and J. Korinek
The Tumultuous Journey of Nesiritide: Past, Present, and Future
Circ Heart Fail, May 1, 2008; 1(1): 6 - 8.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
C. W. Yancy, H. Krum, B. M. Massie, M. A. Silver, L. W. Stevenson, M. Cheng, S. S. Kim, R. Evans, and for the FUSION II Investigators
Safety and Efficacy of Outpatient Nesiritide in Patients With Advanced Heart Failure: Results of the Second Follow-Up Serial Infusions of Nesiritide (FUSION II) Trial
Circ Heart Fail, May 1, 2008; 1(1): 9 - 16.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
S. Herget-Rosenthal, F. Saner, and L. S. Chawla
Approach to Hemodynamic Shock and Vasopressors
Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 546 - 553.
[Full Text] [PDF]

Home page
 CirculationHome page
A. Kazory and E. A. Ross
Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure: A Nephrologic Perspective
Circulation, February 19, 2008; 117(7): 975 - 983.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the Year in JACC 2007
J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. A. Silver and C. W. Yancy
Using Homeostatic Peptides in Decompensated Heart Failure: A Reasonable Paradigm But a Flawed Practice?
J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1841 - 1843.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. M. Witteles, D. Kao, D. Christopherson, K. Matsuda, R. H. Vagelos, D. Schreiber, and M. B. Fowler
Impact of Nesiritide on Renal Function in Patients With Acute Decompensated Heart Failure and Pre-Existing Renal Dysfunction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1835 - 1840.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
F. L. Martin, T. Supaporn, H. H. Chen, S. M. Sandberg, Y. Matsuda, M. Jougasaki, and J. C. Burnett Jr.
Distinct roles for renal particulate and soluble guanylyl cyclases in preserving renal function in experimental acute heart failure
Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1580 - R1585.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
H. H. Chen, T. M. Sundt, D. J. Cook, D. M. Heublein, and J. C Burnett Jr
Low Dose Nesiritide and the Preservation of Renal Function in Patients With Renal Dysfunction Undergoing Cardiopulmonary-Bypass Surgery: A Double-Blind Placebo-Controlled Pilot Study
Circulation, September 11, 2007; 116(11_suppl): I-134 - I-138.
[Abstract] [Full Text] [PDF]

Home page
 Am J Health Syst PharmHome page
A. Dunn and S. Sachak
Nesiritide and renal function after cardiac surgery
Am. J. Health Syst. Pharm., August 1, 2007; 64(15): 1582 - 1584.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
I. Belenkie
Nesiritide Administration in Patients With Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery
J. Am. Coll. Cardiol., February 13, 2007; 49(6): 727 - 728.
[Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement