(Circulation. 2000;101:498.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Hemodynamic, Renal, and Hormonal Effects of Adrenomedullin Infusion in Patients With Congestive Heart Failure
From the Department of Internal Medicine (N.Nagaya, T.S., S.F., F.S., H.O., S.K., N.Nakanishi, Y.G., K.M.) and Research Institute (T.N., K.K.), National Cardiovascular Center, Osaka, Japan; Cardiovascular Division (M.U.), Osaka Police Hospital, Osaka, Japan; and the Third Department of Internal Medicine (Y.M.), Chiba University School of Medicine, Chiba, Japan.
Background—Experimental studies have shown that adrenomedullin (AM) causes vasodilatation, diuresis, and a positive inotropic effect. In humans, however, whether infusion of AM has beneficial effects in congestive heart failure (CHF) remains unknown.
Methods and Results—Hemodynamic, renal, and hormonal responses to intravenous infusion of human AM (0.05 µg · kg-1 · min-1) were examined in 7 patients with CHF and 7 normal healthy subjects (NL). In NL group, AM significantly decreased mean arterial pressure (-16 mm Hg, P<0.05) and increased heart rate (+12 bpm, P<0.05). In CHF group, AM also decreased mean arterial pressure (-8 mm Hg, P<0.05) and increased heart rate (+5 bpm, P<0.05), but to a much lesser degree (P<0.05 versus NL). AM markedly increased cardiac index (CHF, +49%; NL, +39%, P<0.05) while decreasing pulmonary capillary wedge pressure (CHF, -4 mm Hg; NL, -2 mm Hg, P<0.05). AM significantly decreased mean pulmonary arterial pressure only in CHF (-4 mm Hg, P<0.05). AM increased urine volume (CHF, +48%; NL, +62%, P<0.05) and urinary sodium excretion (CHF, +42%; NL, +75%, P<0.05). Only in CHF, plasma aldosterone significantly decreased during (-28%, P<0.05) and after (-36%, P<0.05) AM infusion. These parameters remained unchanged in 7 patients with CHF and 6 healthy subjects who received placebo.
Conclusions—Intravenous infusion of AM has beneficial hemodynamic and renal effects in patients with CHF.
Key Words: heart failure • hemodynamics • cardiac output • natriuretic peptides
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