Preexisting cardiopulmonary disease attenuating the atrial natriuretic peptide response. Results in patients with acute respiratory failure.
The purpose of this study was to evaluate the pathophysiologic role of atrial natriuretic peptide (ANP) as a pulmonary artery vasodilator in patients with acute respiratory failure receiving artificial ventilation. Twenty-one consecutive patients were studied, 12 without and 9 with preexisting cardiopulmonary disease. Pulmonary artery plasma ANP levels were significantly higher than the levels obtained in the superior vena cava and radial artery. Plasma ANP levels correlated significantly with the plasma levels of its second messenger, guanosine 3',5'-cyclic monophosphate (cGMP). In the 12 patients without prior cardiopulmonary disease, plasma ANP levels correlated significantly with mean pulmonary arterial pressure (MPAP). This correlation was not found in the nine patients with preexisting cardiopulmonary disease. The cGMP/ANP ratio, indicating the biologic effect of ANP, was also higher in the patients without preexisting cardiopulmonary disease. These results are compatible with clearance and vasodilator activity of ANP in the pulmonary vascular bed, but only in patients without preexisting cardiopulmonary disease.
Westendorp
R G
RG
Department of General Internal Medicine, University Hospital Leiden, The Netherlands.
Roos
A N
AN
Walma
S T
ST
Frölich
M
M
Meinders
A E
AE
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right / Q000502:physiology; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001794:Blood Pressure / Q000502:physiology; D006152:Cyclic GMP / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D011658:Pulmonary Fibrosis / Q000097:blood / Q000150:complications*; D017534:Radial Artery; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000097:blood* / Q000150:complications* / Q000628:therapy; D014683:Vena Cava, Superior
D009320:Atrial Natriuretic Factor; D006152:Cyclic GMP