Recombinant Human Brain Natriuretic Peptide Ameliorates Venous Return Function in Congestive Heart Failure

Figures

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  Figure 1. Research flow chart. All patients received a loading dose of 2 μg/kg over 15 min and a continuous infusion of 0.01 μg/kg/min for 3 days. Before and after administration of rh‐BNP, some manoeuvres were performed to measure three points induced by postural changes and four points by positive end‐expiratory pressure gradients to depict the Frank‐Starling and venous return curves before and after using rh‐BNP. rh‐BNP, recombinant human brain natriuretic peptide.

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  Figure 2. The cardiac output function and venous return curves. (A) An example of plotting venous return curves and cardiac output function curves. (B, C and D) The instant effects of rh‐BNP on cardiac output function and venous return function curves for all patients, patients with HFrEF or HFmrEF and HFpEF. The blue and orange lines indicated the status before and after using rh‐BNP. The solid lines or curves were the averaged effects while the dashed lines and line segments represented the standard deviation. CI, cardiac index; CVP, central venous pressure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; rh‐BNP, recombinant human brain natriuretic peptide.

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  Figure 3. The schematic picture of the mechanism of rh‐BNP's effects. (A and B) Different stages of acute heart failure and receiving rh‐BNP illustrated by cardiac output function–venous return relation and pressure–volume relation. The black, red, blue, and orange curves indicate normal, acute phase, before and after rh‐BNP, respectively. (C) The comprehensive effects of rh‐BNP. CI, cardiac index; CVP, central venous pressure; EDP, end‐diastolic pressure; EDPVR, end‐diastolic pressure–volume relationship; EDV, end‐diastolic volume; ESV, end‐systolic volume; ESVPR, end‐systolic pressure–volume relationship; MPAP, mean pulmonary artery pressure; PAWP, pulmonary artery wedge pressure; Pmsf, mean systemic filling pressure; PVA, pressure–volume area; PVRI, pulmonary vascular resistance index; SBP, systolic blood pressure; SV, stroke volume; SVI, stroke volume index; SVRI, systemic vascular resistance index; VRRI, venous return resistance index.