Circulation, Vol 80, 1137-1147, Copyright © 1989 by American Heart Association
G Takemura, H Fujiwara, K Horike, M Mukoyama, Y Saito, K Nakao, M Matsuda, A Kawamura, M Ishida and M Kida
To investigate the mechanism of expression of atrial natriuretic
polypeptide (ANP) in human ventricles, we conducted an immunohistochemical
study of ANP in biventricular endomyocardial biopsy specimens obtained from
a total of 49 patients with cardiac dilatation due to dilated
cardiomyopathy (21 patients), postmyocarditis (18 patients), or volume
overload (five patients) and subjects with no dilatation as controls (five
patients). Four-micron thick sections were stained by an indirect
immunoperoxidase method using monoclonal antibody to alpha-human ANP as the
primary antibody. The frequency of ANP-present myocytes was calculated in
each specimen and compared with clinical, echocardiographic, hemodynamic,
angiographic, and histologic parameters. ANP-present myocytes were noted in
all of the 21 patients with dilated cardiomyopathy, in 11 of the 18
patients with postmyocarditis, in four of the five patients with volume
overload, and in zero of the five controls. The mean percentage of
ANP-present myocytes was significantly greater in the left-side specimens
(35 +/- 37%) than in the right-side ones (2 +/- 4%). The percentage of ANP-
present myocytes in the left-side specimens significantly correlated with
peak systolic or end-diastolic wall stress (r = 0.67 and 0.58), left
ventricular end-systolic or end-diastolic volume index (r = 0.75 and 0.69),
or left ventricular end-diastolic pressure (r = 0.42) and inversely
correlated with ejection fraction (r = -0.73), systolic left ventricular
wall thickness (r = -0.58), or cardiac index (r = -0.30). Expression of ANP
was rarely seen in the cases with normal wall stresses, normal ejection
fraction, normal volume, or normal myocyte size. However, it was seen
frequently even in hearts with normal levels of left ventricular
end-diastolic pressure and cardiac index (compensated hearts). The percent
of ANP-present myocytes in both sides significantly correlated with size of
myocytes (r = 0.48 at right and r = 0.57 at left side) or degree of
fibrosis (r = 0.45 at right and r = 0.48 at left side). These results
suggest that ANP expression is augmented in the dilated ventricles
regardless of the causes of dilatation and that the augmentation is a
compensatory mechanism as prevention against decompensation responding to
reduced contractility, excess of wall stresses, or both, concomitantly
occurring with cardiac dilatation and myocardial hypertrophy.
ARTICLES
Ventricular expression of atrial natriuretic polypeptide and its relations with hemodynamics and histology in dilated human hearts. Immunohistochemical study of the endomyocardial biopsy specimens
Third Division, Faculty of Medicine, Kyoto University, Japan.
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