Hemodynamic, renal, and hormonal effects of adrenomedullin infusion in patients with congestive heart failure.
BACKGROUND
Experimental studies have shown that adrenomedullin (AM) causes vasodilatation, diuresis, and a positive inotropic effect. In humans, however, whether infusion of AM has beneficial effects in congestive heart failure (CHF) remains unknown.


RESULTS
Hemodynamic, renal, and hormonal responses to intravenous infusion of human AM (0.05 microg. kg(-1). min(-1)) were examined in 7 patients with CHF and 7 normal healthy subjects (NL). In NL group, AM significantly decreased mean arterial pressure (-16 mm Hg, P<0. 05) and increased heart rate (+12 bpm, P<0.05). In CHF group, AM also decreased mean arterial pressure (-8 mm Hg, P<0.05) and increased heart rate (+5 bpm, P<0.05), but to a much lesser degree (P<0.05 versus NL). AM markedly increased cardiac index (CHF, +49%; NL, +39%, P<0.05) while decreasing pulmonary capillary wedge pressure (CHF, -4 mm Hg; NL, -2 mm Hg, P<0.05). AM significantly decreased mean pulmonary arterial pressure only in CHF (-4 mm Hg, P<0.05). AM increased urine volume (CHF, +48%; NL, +62%, P<0.05) and urinary sodium excretion (CHF, +42%; NL, +75%, P<0.05). Only in CHF, plasma aldosterone significantly decreased during (-28%, P<0.05) and after (-36%, P<0.05) AM infusion. These parameters remained unchanged in 7 patients with CHF and 6 healthy subjects who received placebo.


CONCLUSIONS
Intravenous infusion of AM has beneficial hemodynamic and renal effects in patients with CHF.
Nagaya
N
N
Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan.
Satoh
T
T
Nishikimi
T
T
Uematsu
M
M
Furuichi
S
S
Sakamaki
F
F
Oya
H
H
Kyotani
S
S
Nakanishi
N
N
Goto
Y
Y
Masuda
Y
Y
Miyatake
K
K
Kangawa
K
K
D053607:Adrenomedullin; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006728:Hormones / Q000097:blood*; D006801:Humans; D007275:Injections, Intravenous; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D006728:Hormones; D010455:Peptides; D053607:Adrenomedullin