Circulation, Vol 87, 2016-2022, Copyright © 1993 by American Heart Association
MM Redfield, LL Aarhus, RS Wright and JC Burnett Jr
BACKGROUND. Recent studies have reported that asymptomatic left ventricular
dysfunction (ALVD) in humans is characterized by early neurohumoral
activation. Specifically, atrial natriuretic factor (ANF) and
norepinephrine are activated without activation of the renin-
angiotensin-aldosterone system (RAAS). The current study describes
hemodynamic and renal function associated with this neurohumoral profile in
a canine model of early and presumably "asymptomatic" ventricular
dysfunction. We hypothesized that the neurohumoral profile observed in ALVD
is associated with preservation of renal function despite significant
hemodynamic compromise. METHODS AND RESULTS. ALVD was produced by
ventricular pacing at 180 beats per minute for 10 days. Intravascular
volume expansion was performed before and after producing ALVD in eight
conscious dogs. The model of ALVD was characterized by decreases in
ejection fraction (48 +/- 2 to 29 +/- 4%), cardiac output (4.64 +/- 0.29 to
2.89 +/- 0.17 L/min), and mean arterial pressure (119 +/- 4 to 108 +/- 4 mm
Hg). Atrial pressures and systemic vascular resistance were increased. ANF
(60 +/- 19 to 165 +/- 27 pg/mL) and norepinephrine (382 +/- 127 to 690 +/-
211 pg/mL) were activated, whereas the RAAS was not. Creatinine clearance
and sodium excretion (UNa V) were unchanged after producing ALVD. The
natriuretic response to volume expansion in ALVD was completely intact,
with increases in UNa V similar to that observed with volume expansion in
ALVD was completely intact, with increases in UNa V similar to that
observed with volume expansion before producing ALVD. CONCLUSIONS. The
current study demonstrates that significant ventricular dysfunction with
peripheral vasoconstriction can be associated with normal renal function
and thus suggests an important functional role for the neurohumoral profile
of ALVD in preserving sodium balance.
ARTICLES
Cardiorenal and neurohumoral function in a canine model of early left ventricular dysfunction
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn.
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