Circulation, Vol 87, 464-469, Copyright © 1993 by American Heart Association
M Yoshimura, H Yasue, K Okumura, H Ogawa, M Jougasaki, M Mukoyama, K Nakao and H Imura
BACKGROUND. The plasma levels of atrial natriuretic peptide (ANP) and brain
natriuretic peptide (BNP) are increased in relation to the severity of
congestive heart failure (CHF). This study was designed to examine whether
the secretion patterns of ANP and BNP vary with underlying cardiac
disorders of CHF with different degrees of overload in atria and
ventricles. METHODS AND RESULTS. We measured plasma levels of ANP and BNP
in the aorta in 20 patients with mitral stenosis (MS) in whom atria are
mainly overloaded, 30 patients with dilated cardiomyopathy (DCM) in whom
both atria and ventricles are overloaded, and 20 control subjects during
cardiac catheterization. Pulmonary capillary wedge pressure (PCWP) was
significantly higher in the MS and DCM groups (16.7 +/- 4.7 mm Hg and 15.1
+/- 7.7 mm Hg, respectively) than in the control group (7.2 +/- 1.1 mm Hg,
p < 0.01), whereas there was no significant difference between the MS
and DCM groups. Left ventricular end-diastolic pressure (LVEDP) was
significantly higher in the DCM group than in the MS group (16.4 +/- 7.8 mm
Hg versus 7.6 +/- 2.0 mm Hg, p < 0.01), and the level was comparable
between the MS and control groups (7.6 +/- 2.0 mm Hg versus 6.8 +/- 1.2 mm
Hg, p = NS). The plasma ANP level was significantly higher in the MS and
DCM groups (356 +/- 169 pg/ml and 331 +/- 323 pg/ml, respectively) than in
the control group (98 +/- 41 pg/ml, p < 0.01), whereas there was no
significant difference between the MS and DCM groups. The plasma BNP level
was significantly higher in the DCM group than in the MS group (333 +/- 405
pg/ml versus 147 +/- 54 pg/ml, p < 0.01), and the level was
significantly higher in the MS group than in the control group (147 +/- 54
pg/ml versus < 10 pg/ml, p < 0.01). The plasma levels of ANP and BNP
had a highly positive correlation with PCWP in the DCM group (p < 0.01).
On the other hand, in the MS group, the plasma ANP level had a highly
significant correlation with PCWP (p < 0.01) but the plasma BNP level
did not. CONCLUSIONS. We conclude that plasma levels of BNP mainly reflect
the degree of ventricular overload and that the secretion patterns of ANP
and BNP vary with underlying cardiac disorders of CHF with different
degrees of overload in atria and ventricles.
ARTICLES
Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure
Division of Cardiology, Kumamoto University School of Medicine, Japan.
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H. P. B.-L. Rocca, D. Weilenmann, H. Rickli, F. Follath, and W. Kiowski Is Blood Pressure Response to the Valsalva Maneuver Related to Neurohormones, Exercise Capacity, and Clinical Findings in Heart Failure? Chest, October 1, 1999; 116(4): 861 - 867. [Abstract] [Full Text] [PDF]
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T. Matsumoto, A. Wada, T. Tsutamoto, T. Omura, H. Yokohama, M. Ohnishi, I. Nakae, M. Takahashi, and M. Kinoshita Vasorelaxing effects of atrial and brain natriuretic peptides on coronary circulation in heart failure Am J Physiol Heart Circ Physiol, June 1, 1999; 276(6): H1935 - H1942. [Abstract] [Full Text] [PDF]
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T. Hiramatsu, Y. Imai, Y. Takanashi, K. Seo, M. Terada, and M. Nakazawa Hemodynamic Effects of Human Atrial Natriuretic Peptide After Modified Fontan Procedure Ann. Thorac. Surg., March 1, 1998; 65(3): 761 - 764. [Abstract] [Full Text]
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S. Daggubati, J. R Parks, R. M Overton, G. Cintron, D. D Schocken, and D. L Vesely Adrenomedullin, endothelin, neuropeptide Y, atrial, brain, and C-natriuretic prohormone peptides compared as early heart failure indicators Cardiovasc Res, November 1, 1997; 36(2): 246 - 255. [Abstract] [Full Text] [PDF]
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T. Tsutamoto, A. Wada, K. Maeda, T. Hisanaga, Y. Maeda, D. Fukai, M. Ohnishi, Y. Sugimoto, and M. Kinoshita Attenuation of Compensation of Endogenous Cardiac Natriuretic Peptide System in Chronic Heart Failure : Prognostic Role of Plasma Brain Natriuretic Peptide Concentration in Patients With Chronic Symptomatic Left Ventricular Dysfunction Circulation, July 15, 1997; 96(2): 509 - 516. [Abstract] [Full Text]
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A. E. Gamel, N. A. Yonan, B. Keevil, R. Warbuton, J. Kakadellis, A. Woodcock, C. S. Campbell, A. N. Rahman, and A. K. Deiraniya Significance of Raised Natriuretic Peptides After Bicaval and Standard Cardiac Transplantation Ann. Thorac. Surg., April 1, 1997; 63(4): 1095 - 1100. [Abstract] [Full Text]
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L. S. Marcus, D. Hart, M. Packer, M. Yushak, N. Medina, R. S. Danziger, D. F. Heitjan, and S. D. Katz Hemodynamic and Renal Excretory Effects of Human Brain Natriuretic Peptide Infusion in Patients With Congestive Heart Failure: A Double-Blind, Placebo-Controlled, Randomized Crossover Trial Circulation, December 15, 1996; 94(12): 3184 - 3189. [Abstract] [Full Text]
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R. O. Bonow New Insights Into the Cardiac Natriuretic Peptides Circulation, June 1, 1996; 93(11): 1946 - 1950. [Full Text]
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T. Omland, A. Aakvaag, V. V. S. Bonarjee, K. Caidahl, R. T. Lie, D. W. T. Nilsen, J. A. Sundsfjord, and K. Dickstein Plasma Brain Natriuretic Peptide as an Indicator of Left Ventricular Systolic Function and Long-term Survival After Acute Myocardial Infarction : Comparison With Plasma Atrial Natriuretic Peptide and N-Terminal Proatrial Natriuretic Peptide Circulation, June 1, 1996; 93(11): 1963 - 1969. [Abstract] [Full Text]
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G. La Villa, L. Stefani, C. Lazzeri, C. Zurli, C. T. Guerra, G. Barletta, R. Bandinelli, G. Strazzulla, and F. Franchi Acute Effects of Physiological Increments of Brain Natriuretic Peptide in Humans Hypertension, October 1, 1995; 26(4): 628 - 633. [Abstract] [Full Text]
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