title: Plasma concentrations of atrial and brain natriuretic peptides and cyclic guanosine monophosphate in response to dobutamine infusion in patients with surgically repaired tetralogy of fallot.
abstract: We examined the plasma concentrations of atrial and brain natriuretic peptides (ANP and BNP) and cyclic guanosine monophosphate (cGMP) during dobutamine infusion and their relationship with hemodynamic parameters in 14 patients with surgically repaired tetralogy of Fallot (TOF). Dobutamine was infused at an initial dose of 5 microgram/kg/min and increased by 5 microgram/kg/min up to 20 microgram/kg/min. The plasma ANP, BNP, and cGMP concentrations were determined before infusion, at the end of each stage, and 15 minutes after discontinuing dobutamine infusion. The plasma concentrations of ANP, BNP, and cGMP were elevated in all patients before dobutamine infusion. The ANP, BNP, and cGMP concentrations decreased in 11 of the 14 patients during dobutamine infusion. In contrast, the plasma ANP and BNP concentrations increased in the remaining 3 patients without a change in the cGMP concentration. The right ventricular pressure and volume were significantly elevated in these patients. The plasma cGMP concentration correlated with the ANP concentration (r = 0.62, p < 0.01) but not the BNP concentration. The plasma ANP concentration during dobutamine infusion correlated with right ventricular systolic pressure (r = 0.71, p < 0.05), mean right atrial pressure (r = 0.29, p < 0.05), and mean pulmonary capillary wedge pressure (r = 0.32, p < 0.05). The BNP concentration correlated with right ventricular volume (r = 0.61, p < 0.05) and systolic pressure (r = 0. 46, p < 0.05). In conclusion, rapid changes in ANP, BNP, and cGMP concentrations during dobutamine infusion reflect the changes in atrial and ventricle pressure and volume overload. In surgically repaired TOF, the ANP concentration is affected by right ventricular systolic pressure, right atrial pressure, and pulmonary capillary pressure. Furthermore, the BNP concentration reflects right ventricular pressure and volume overload.
authors.affiliation: Department of Pediatrics, University of Tokushima, Kuramoto-cho-2, Tokushima 770-8503, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Hayabuchi
authors.forename: S
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Y
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D009320:Atrial Natriuretic Factor / Q000097:blood* / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D002306:Cardiac Volume / Q000187:drug effects; D002316:Cardiotonic Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D002675:Child, Preschool; D006152:Cyclic GMP / Q000097:blood*; D004280:Dobutamine / Q000494:pharmacology*; D016903:Drug Monitoring; D006801:Humans; D007262:Infusions, Intravenous; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000187:drug effects*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013599:Systole / Q000187:drug effects; D013771:Tetralogy of Fallot / Q000097:blood* / Q000188:drug therapy* / Q000601:surgery; D017725:Ventricular Pressure / Q000187:drug effects
chemical_list: D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D009320:Atrial Natriuretic Factor; D006152:Cyclic GMP