Intravenous adrenomedullin in myocardial function and energy metabolism in patients after myocardial infarction.
This study investigated the effects of adrenomedullin on left ventricular myocardial contraction and relaxation, coronary blood flow, and myocardial oxygen consumption in comparison with those of atrial natriuretic peptide (ANP). Fourteen patients who had had myocardial infarctions were randomly assigned to receive IV infusion of adrenomedullin (0.05 microg/kg/min) or ANP (0.05 microg/kg/min). Both adrenomedullin and ANP significantly decreased left ventricular systolic pressure (-17 mm Hg, -13 mm Hg, respectively, both p < 0.05). The increase in cardiac index by adrenomedullin (+31%) was significantly greater than that by ANP (+16%). Adrenomedullin significantly increased an index of myocardial contractility, Emax (2.5 +/- 0.3 mm Hg-3.7 +/- 0.3 mm Hg/ml, p < 0.05) and shortened an index of myocardial relaxation, Tau (52 +/- 5 ms-48 +/- 4 ms, p < 0.05). In contrast, ANP did not significantly alter either parameter. In addition, adrenomedullin, but not ANP, significantly increased coronary sinus blood flow (73 +/- 10 ml/min-86 +/- 10 ml/min, p < 0.05). Adrenomedullin did not increase myocardial oxygen consumption. Unlike ANP, IV administration of adrenomedullin enhanced left ventricular myocardial contraction and improved left ventricular relaxation without increasing myocardial oxygen consumption in patients who had had a myocardial infarction.
Nagaya
Noritoshi
N
Department of Internal Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Goto
Yoichi
Y
Satoh
Toru
T
Sumida
Hitoshi
H
Kojima
Sunao
S
Miyatake
Kunio
K
Kangawa
Kenji
K
D053607:Adrenomedullin; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004734:Energy Metabolism / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism*; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D016277:Ventricular Function, Left / Q000187:drug effects*
D002316:Cardiotonic Agents; D010455:Peptides; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor