Atrial natriuretic peptide kinetic studies in patients with cardiac dysfunction.
Three studies were performed: (1) a controlled investigation of alpha-human atrial natriuretic peptide (alpha-hANP) total body production and metabolic clearance rates using a bolus infusion technique (controls, patients 1 to 6); (2) a study of alpha-hANP kinetics in cardiac dysfunction patients using a constant infusion method (patients 7 to 14); and (3) a right heart catheterization study to determine the amount of alpha-hANP released into the circulation at the level of the right heart, estimated by the step-up in alpha-hANP concentration between the superior and inferior vena cava and the pulmonary artery, in the patients with left ventricular dysfunction. Baseline venous plasma alpha-hANP was 27.3 +/- 16.5 pg/ml in the controls (mean +/- SD; N = 6), 141.6 +/- 138.0 pg/ml in patients 1 to 6 (P less than 0.05 compared to controls), and 167.5 +/- 145.7 pg/ml in patients 7 to 14. Total body alpha-hANP production rate was markedly elevated in patients 1 to 6 compared to controls (0.45 +/- 0.36 vs. 0.11 +/- 0.06 micrograms/min, P less than 0.05) and was similar to that determined by the continuous infusion technique in patients 7 to 14 (0.62 +/- 0.44 micrograms/min, P = 0.49 compared to patients 1 to 6). alpha-hANP release into the right heart (0.17 +/- 0.11 micrograms/min), however, was significantly lower than total body production rate in the cardiac dysfunction patients, indicating that total body alpha-hANP secretion occurs from sites in addition to drainage into the right heart via the coronary sinus and anterior cardiac veins. Right atrial pressure correlated with the alpha-hANP released into the right heart.(ABSTRACT TRUNCATED AT 250 WORDS)
Hensen
J
J
Department of Medicine, University of Colorado School of Medicine, Denver.
Abraham
W T
WT
Lesnefsky
E J
EJ
Levenson
B
B
Groves
B M
BM
Schröder
K
K
Schrier
R W
RW
Dürr
J
J
D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism*; D006328:Cardiac Catheterization; D005260:Female; D006331:Heart Diseases / Q000378:metabolism*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left / Q000502:physiology
D009320:Atrial Natriuretic Factor