ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－281－JS1-4 Acute efficacy and safety of vasodilators（carperitide or nicorandil）in patients hospitalized for acute decompensated heart failureDivision of Cardiology, Sekikawa Hospital, Tokyo, JapanKatsuya KajimotoAcute decompensated heart failure（ADHF）is defined as gradual or rapid progression of the signs and symptoms of heartfailure that results in the need for urgent treatment. Patients with ADHF need to be stabilized by early administration ofdiuretics, vasodilators, inotropes, and/or noninvasive ventilation. Recently, it has been suggested that early initiation of treatmentwith some of the newer pharmacological agents may achieve a more favorable outcome. Among the currently availablevasodilators, natriuretic peptide preparations such as nesiritide and carperitide（recombinant human brain and atrial natriureticpeptide, respectively）achieve significant reduction of the venous and ventricular filling pressures with subsequent rapidimprovement of dyspnea or orthopnea. Nesiritide was reported to achieve a significantly greater decrease of the left ventricularfilling pressure compared with nitroglycerin, suggesting that it is indicated as the initial treatment for patients with ADHF anddyspnea at rest. Carperitide has been approved for ADHF in Japan, and it was reported that signs and symptoms wereimproved by carperitide therapy in approximately 80% of ADHF patients with an adequate systolic blood pressure. Recently, ithas also been reported that intravenous infusion of nicorandil can immediately improve hemodynamics of ADHF patients.Nicorandil is a nicotinamide ester that dilates the peripheral and coronary resistance vessels by acting on the ATP-sensitivepotassium channel, and also possesses a nitrate moiety that promotes systemic venous and coronary vasodilatation, leading tothe improvement of dyspnea in patients with ADHF. Several recent sets of guidelines for the management of ADHF havesuggested that vasodilator therapy should be considered for ADHF patients with a high to normal BP on admission and shouldbe avoided in those with a low BP. However, these guidelines do not specifically address the strategy for early medicaltreatment, because there is limited evidence about the efficacy of the pharmacological agents currently used for ADHF.Therefore, in this session, we plan to show an acute efficacy and safety of initial carperitide or nicorandil therapy in patientshospitalized for ADHF.