Akut dekompensierte Herzinsuffizienz: klinischer Stellenwert einer Therapie mit natriuretischen Peptiden

 

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Zusammenfassung

Die dekompensierte Herzinsuffizienz ist eine der häufigsten Ursachen für Krankenhauseinweisungen bei älteren Patienten. Im Gegensatz zur Behandlung der chronischen Herzinsuffizienz gab es in den letzten Dekaden wenig beachtliche Fortschritte in der Pharmakotherapie der akut dekompensierten Herzinsuffizienz. Zudem ist die Verwendung der aktuellen Standardtherapie mit wesentlichen Limitationen im klinischen Einsatz verbunden.

Die Familie der natriuretischen Peptide (NP) besteht aus mehreren strukturell sehr ähnlichen Polypeptiden (ANP, BNP, CNP, Urodilatin, DNP). Die am besten untersuchten Substanzen ANP und BNP wirken vasodilatierend, natriuretisch, antiproliferativ und stellen einen wichtigen kompensatorischen Mechanismus bei chronischer Herzinsuffizienz dar.

Mit Nesiritid steht ein rekombinantes humanes BNP zur Verfügung, dessen Wirksamkeit bei Herzinsuffizienz in mehreren Studien nachgewiesen werden konnte. Eine große Metaanalyse zeigte jedoch eine Nesiritid-assoziierte tendenziell erhöhte 30-Tage-Mortalitätsrate. Urodilatin, eine Prozessierungsvariante des pro-ANP, zeigt günstige hämodynamische Eigenschaften in den ersten Studien mit kleineren Patientenzahlen.

Obwohl Nesiritid in einigen Ländern zur Therapie der dekompensierten Herzinsuffizienz zugelassen ist, ist sein klinischer Stellenwert derzeit unklar. Urodilatin könnte evtl. als Alternative dienen.

Abstract

Heart failure is the most frequent cause of hospitalization in elderly population. Unlike the therapy of congestive heart failure, there was only a modest progress in the medical treatment for acutely decompensated heart failure over the past several decades. Moreover, current treatment is associated with many limitations in clinical practice.

The family of natriuretic peptides consists of several structurally similar polypeptides (ANP, BNP, CNP, urodilatin, DNP). ANP and BNP are the most characterized substances and represent an important compensatory mechanisms in heart failure because of their vasodilatory, natriuretic and antiproliferative effects.

Nesiritide is a recombinant human BNP which has been shown to be effective in treating heart failure in several clinical trials. However, a recent meta-analysis revealed a nesiritide-associated increased 30-day-mortality rate. The results of initial small-sized trials suggest beneficial hemodynamic effects of urodilatin in decompensated heart failure.

Despite of being approved for the treatment of decompensated heart failure in some countries, the clinical relevance of nesiritide is currently unclear. Urodilatin might represent a potential alternative.

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Priv.-Doz. Dr. Natig Gassanov

Herzzentrum Köln
Klinik III für Innere Medizin

Kerpener Str. 62

50924 Köln

Phone: 0221/478-32544

Fax: 0221/478-32712

Email: Natig.Gassanov@uk-koeln.de