7492
document
Acute hemodynamic effects of conivaptan , a dual V ( 1A ) and V ( 2 ) vasopressin receptor antagonist , in patients with advanced heart failure . BACKGROUND Arginine vasopressin may contribute to abnormalities in hemodynamics and fluid balance in heart failure through its actions on V ( 1A ) ( vascular and myocardial effects ) and V ( 2 ) receptors ( renal effects ) . Inhibiting the action of vasopressin may be beneficial in patients with heart failure . METHODS AND RESULTS A total of 142 patients with symptomatic heart failure ( New York Heart Association class III and IV ) were randomized to double-blind , short-term treatment with conivaptan , a dual V ( 1a ) /V ( 2 ) vasopressin receptor antagonist , at a single intravenous dose ( 10 , 20 , or 40 mg ) or placebo . Compared with placebo , conivaptan at 20 and 40 mg significantly reduced pulmonary capillary wedge pressure ( -2.6+/-0.7 , -5.4+/-0.7 , and -4.6+/-0.7 mm Hg for placebo and 20 and 40 mg groups , respectively ; P < 0.05 ) and right atrial pressure ( -2.0+/-0.4 , -3.7+/-0.4 , and -3.5+/-0.4 mm Hg for placebo and 20 and 40 mg groups , respectively ; P < 0.05 ) during the 3- to 6-hour interval after intravenous administration . Conivaptan significantly increased urine output in a dose-dependent manner ( -11+/-17 , 68+/-17 , 152+/-19 , and 176+/-18 mL/hour for placebo and 10 , 20 , and 40 mg groups , respectively ; P < 0.001 ) during the first 4 hours after the dose . Changes in cardiac index , systemic and pulmonary vascular resistance , blood pressure , and heart rate did not significantly differ from placebo . CONCLUSIONS In patients with advanced heart failure , vasopressin receptor antagonism with conivaptan resulted in favorable changes in hemodynamics and urine output without affecting blood pressure or heart rate . These data suggest that vasopressin is functionally significant in advanced heart failure and that further investigations are warranted to examine the effects of conivaptan on symptom relief and natural history in such patients .
7493
Intervention_Pharmacological
conivaptan
7494
Intervention_Pharmacological
conivaptan
7495
Intervention_Pharmacological
vasopressin
7496
Intervention_Control
placebo
7497
Intervention_Pharmacological
Conivaptan
7498
Intervention_Pharmacological
conivaptan
7499
Outcome_Physical
Acute hemodynamic effects
7500
Outcome_Physical
abnormalities in hemodynamics and fluid balance
7501
Outcome_Physical
V ( 1A ) ( vascular and myocardial effects ) and V ( 2 ) receptors ( renal effects ) .
7502
Outcome_Physical
pulmonary capillary wedge pressure
7503
Outcome_Physical
right atrial pressure
7504
Outcome_Physical
urine output
7505
Outcome_Physical
cardiac index , systemic and pulmonary vascular resistance , blood pressure , and heart rate
7506
Outcome_Physical
hemodynamics and urine output
7507
Outcome_Physical
blood pressure or heart rate .
7508
Participant_Condition
advanced heart failure
7509
Participant_Condition
heart failure .
7510
Participant_Sample-size
142 patients
7511
Participant_Condition
symptomatic heart failure
7512
Participant_Condition
advanced heart failure