[Hemodynamic and neurohumoral effects of carperitide (alpha-human atrial natriuretic peptide) in dogs with low-output heart failure]

Tricuspid valve chordal rupture in a dog with pulmonary hypertension

Background:

Rupture of the chordae tendineae of the tricuspid valve is rare in dogs. We report the case of a dog with tricuspid valve chordal rupture secondary to pulmonary hypertension.

Case Description:

A 7.7-kg, 13-year-old neutered male Pekingese on annual heartworm prevention presented with respiratory distress. The patient received a diagnosis of pulmonary hypertension and received medical treatment. However, the patient re-presented 405 days post-diagnosis with dyspnea and an increased abdominal circumference. Transthoracic echocardiography showed ruptured chordae tendineae of the tricuspid valve, and abdominal ultrasound identified significant ascites associated with worsening right congestive heart failure. The patient improved after draining ascitic fluid and extra medical treatment, but was released with poor prognosis.

Conclusion:

Ruptured chordae tendineae of the tricuspid valve should be considered in patients with pulmonary hypertension.

Discovery and in vivo effects of novel human natriuretic peptide receptor A (NPR-A) agonists with improved activity for rat NPR-A

Natriuretic peptide receptor A (NPR-A) agonists were evaluated in vivo by optimizing the structure of quinazoline derivatives to improve agonistic activity for rat NPR-A. A 1,4-Cis-aminocyclohexylurea moiety at 4-position and hydroxy group of d-alaninol at 2-position on the quinazoline ring were found to be important factors in improving rat NPR-A activity. We identified potent quinazoline and pyrido[2,3-d]pyrimidine derivatives against rat NPR-A, with double-digit nanomolar EC₅₀ values. The in vivo results showed that compound 56b administered at 1.0 mg/kg/min significantly increased plasma cGMP concentration and urine volume in rats. We discovered novel potent NPR-A agonists that showed agonistic effects similar to those of atrial natriuretic peptide.

Human atrial natriuretic peptide treatment for acute heart failure: a systematic review of efficacy and mortality

BACKGROUND

The objectives of this study were to assess the effect of human atrial natriuretic peptide (hANP) treatment on physiological parameters and mortality in acute heart failure.

METHODS

The MEDLINE (1966-2009), EMBASE (1980-2009), Cochrane Central Register of Controlled Trials (1991-2009), American College of Physicians Journal Club (1991), Ichushi (Japana Centra Revuo Medicina) (1983-2009), Cinni (NII Scholarly and Academic Information Navigator) (1959-2009), National Diet Library Online Public Access Catalog (1969-2009), Webcat Plus (Japanese National Institute of Informatics) (1986-2009), Medical Online (1947-2009), and JST China (1981-2009) databases were searched for studies that compared the efficacy of hANP and the mortality in patients with acute heart failure with placebo controls. Only randomized controlled trials (RCTs) were included in the study.

RESULTS

Out of 347 articles, a total of 4 studies involving 220 patients with acute heart failure fulfilled the predefined inclusion criteria. There were significant differences in the hemodynamic parameters between the hANP and placebo groups, especially in the pulmonary capillary wedge pressure (PCWP) reduction (standard mean difference [SMD] 2.07; 95% confidence interval [CI], 0.34-3.81) and the cardiac index (SMD 1.79; 95% CI, 0.12-3.47). No statistically significant differences in mortality rates were found (relative risk 1.03; 95% CI, 0.27-3.92).

CONCLUSIONS

In a limited number of studies, hANP appears to improve several hemodynamic parameters, including pulmonary capillary wedge pressure and cardiac index, but not mortality. Further high-quality studies are needed to corroborate these results.