Atrial natriuretic peptide in diabetic and nondiabetic patients with and without heart transplantation.
BACKGROUND
Natriuretic peptides are useful markers for risk stratification of patients with heart disease. However, conflicting results have been reported about circulating atrial natriuretic peptide (ANP) concentration in heart transplant recipients.


METHODS
To ascertain the effects of diabetes and acute insulin administration on plasma ANP concentrations in a model of heart denervation, we studied 12 diabetic (D-OHT) and 6 nondiabetic heart-transplanted (OHT) patients using the euglycemic-hyperinsulinemic clamp and oral glucose tolerance tests. Five patients with type 2 diabetes without heart transplantation (D) and 9 healthy subjects (NOR) matched for anthropometric features served as the controls.


RESULTS
Means baseline plasma ANP concentration was higher in D-OHT (82 +/- 15 pg/mL) than in OHT or NOR (27 +/- 4 or 30 +/- 5; P < .01), but was not different than D (69 +/- 12; P = .82). During the clamp plasma ANP showed similar increases in all groups (49 +/- 4, 39 +/- 3, 59 +/- 4, and 49 +/- 3% in D-OHT, OHT, D, and NOR; P < .02 vs basal, P = NS among groups). Plasma osmolarity and catecholamines were also not different among groups and did not increase during the clamp. Fasting plasma ANP concentrations correlated with plasma glucose concentrations measured 120 minutes after oral glucose tolerance testing.


CONCLUSIONS
Among heart transplantation recipients fasting plasma ANP concentrations were not different at 5 to 6 years after the surgical procedure than in nondiabetic controls. Increased ANP concentrations were observed among recipients with diabetes and among nontransplanted diabetic patients. Although the insulin-induced increment in ANP concentrations was not different among groups, circulating ANP was strongly associated with glucose tolerance status.
Benedini
S
S
Nutrition and Metabolism Unit, San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy.
Fiocchi
R
R
Battezzati
A
A
Serení Piceni
L
L
Gamba
A
A
Mammana
C
C
Bevilacqua
M
M
Perseghin
G
G
Luzi
L
L
D009320:Atrial Natriuretic Factor / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood / Q000601:surgery*; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D016027:Heart Transplantation / Q000502:physiology*; D006728:Hormones / Q000097:blood; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D009320:Atrial Natriuretic Factor; D006442:Glycated Hemoglobin; D006728:Hormones; D007328:Insulin