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Sodium nitroprusside for advanced low-output heart failure
Wilfried Mullens1, Zuheir Abrahams, Gary S Francis
1Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Journal of the American College of Cardiology
|July 12, 2008
Summary
Sodium nitroprusside (SNP) improved hemodynamics and reduced mortality in acute decompensated heart failure (ADHF) patients with low cardiac output. This vasodilator therapy offers favorable long-term outcomes, even with inotropic support or renal dysfunction.
Area of Science:
- Cardiology
- Pharmacology
- Critical Care Medicine
Background:
- Inotropic therapy is standard for acute decompensated heart failure (ADHF) with low cardiac output.
- Alternative or adjunctive therapies are needed to improve outcomes in these high-risk patients.
Purpose of the Study:
- To evaluate the safety and efficacy of sodium nitroprusside (SNP) in patients with ADHF and low-output states.
- To compare clinical outcomes between patients treated with SNP and those receiving standard care.
Main Methods:
- Retrospective review of ADHF patients with cardiac index <= 2 L/min/m^2 between 2000-2005.
- Nonrandomized administration of SNP, titrated to target mean arterial pressure (65-70 mm Hg).
- Comparison of hemodynamic parameters, renal function, inotropic support, and mortality between SNP and control groups.
Main Results:
- SNP treatment was associated with higher central venous and pulmonary capillary wedge pressures.
- SNP use did not increase inotropic support or worsen renal function.
- SNP patients showed improved hemodynamics, higher oral vasodilator prescription at discharge, and significantly lower all-cause mortality (29% vs. 44%).
Conclusions:
- Vasodilator therapy with SNP, alongside optimal medical management, may improve long-term outcomes in advanced low-output heart failure.
- SNP is a viable therapeutic option for hospitalized ADHF patients, irrespective of inotropic use or renal status.
- SNP use is linked to reduced mortality without increased rehospitalization in this patient cohort.
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