The Use of Nesiritide in the Management of Acute Diastolic Heart Failure
Patients with diastolic heart failure often have high pressure in their heart and lungs and
many symptoms such as shortness of breath, low energy, fluid retention, and fatigue.
Decreasing the pressure in the heart and lungs may help these patients feel better. The
drug nesiritide was designed to help treat heart failure. It has also been shown to help
decrease the pressure in the lungs.
Before treatment starts, you will be asked questions about your medical history and about
any medications you are currently taking. You will have a complete physical exam. You will
have an electrocardiogram (ECG - a test that measures the electrical activity of the heart)
and routine blood tests (about 2 teaspoons). You will have an ultrasound on your heart
called an echocardiogram to measure your heart function and the pressures in your lungs.
Your ability to breathe will be evaluated. With the aid of the research nurse, you will
have a 6-minute walk test. You may stop or sit down at any time during the test. This test
is being done to evaluate your energy level. You will also be asked to complete a
questionnaire about your symptoms. This questionnaire should take no more than 10 minutes to
In order to measure the pressure in your heart and lungs, you will have a procedure called a
"right heart catheterization". This is a procedure that may have been done as part of your
standard of care even if you were not enrolled in this study. For this procedure, a small
tube will be placed in a vein in your neck. A longer tube will be inserted into the first
tube and fed through the vein and into your heart. This tube will be used to measure the
pressure in your heart and lungs. After the pressures are measured, you will receive
treatment with nesiritide during the right heart catheterization procedure.
Nesiritide will be given as a continuous infusion (for 48 hours) by vein. The pressures in
your heart and lungs will be measured again at 15, 30, then 60 minutes after you begin to
receive nesiritide. The tubes will then be removed from your heart. You will be awake
during this procedure and lying flat on your back. An anesthetic will be used to numb the
area of your neck where the tube is placed. The entire procedure (including treatment)
should take no longer than 1 hour. You will have an ultrasound of your heart performed
immediately before and after the right heart catheterization.
Within 15 minutes of the end of the procedure the echocardiogram, the 6-minute walk test,
and the questionnaire about your symptoms will be repeated and your breathing will be
The nesiritide infusion will remain going through a vein in your arm for the next 48 hours.
During this infusion you will remain in the hospital on telemetry floor so that researchers
can monitor your blood pressure and watch for irregular heartbeat. After you have received
this drug for 48 hours, the drug will be stopped. Within 24 hours after stopping treatment,
an echocardiogram and a 6-minute walk test will be performed. You will also answer
questions about your breathing and your quality of life. These should take no more than 15
minutes of your time to complete.
You will be taken off study if your condition gets worse or intolerable side effects occur.
At 2 and 4 weeks after your hospitalization and the right heart procedure, you will have
follow-up visits scheduled. At these visits, you will have a complete physical exam, and
possibly have blood work done if required by the doctor as part of your routine care. A
blood test to check a BNP (B-type natriuretic peptide) level will also be performed . This
is a special blood test to give researchers information about your heart and how much extra
fluid you may be carrying with you because of your heart disease. Only 1 teaspoon of blood
is needed for this test although up to 3 teaspoons of blood may need to be drawn depending
of what blood tests your doctor orders at the follow-up visits.
This is an investigational study. Nesiritide is FDA approved and is commercially available
for the treatment of heart failure. However, the use of nesiritide for diastolic heart
failure is under research. About 20 patients will take part in this study. All will be
enrolled at UTMDACC.
The patient population recruited for this study will include patients being admitted for
acute congestive heart failure. Eligible patients include those who have near normal LV
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Effectiveness of nesiritide in improving symptoms, including pressure in heart and lungs, related to diastolic heart failure (condition where heart muscle is stiff and not able to relax completely, causing the pressures in heart to increase).
Jean-Bernard Durand, MD
UT MD Anderson Cancer Center
United States: Food and Drug Administration