atrial-natriuretic-factor and Aortic-Aneurysm--Abdominal

The serine proteases of the trypsin superfamily are versatile enzymes involved in a variety of biological processes. In the cardiovascular system, the importance of these enzymes in blood coagulation, platelet activation, fibrinolysis, and thrombosis has been well established. Recent studies have shown that trypin-like serine proteases are also important in maintaining cardiac function and contribute to heart-related disease processes. In this review, we describe the biological function of corin, tissue kallikrein, chymase and urokinase and discuss their roles in cardiovascular diseases such as hypertension, cardiac hypertrophy, heart failure, and aneurysm.

Topics: Animals; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Cardiomegaly; Chymases; Heart; Humans; Hypertension; Hypertension, Pulmonary; Myocardial Ischemia; Serine Endopeptidases; Tissue Kallikreins; Urokinase-Type Plasminogen Activator

To assess the effect of human atrial natriuretic peptide (HANP) on the pulmonary and systemic circulations during infrarenal abdominal aortic aneurysmectomy.. A prospective, randomized study.. A university hospital.. Forty-five patients undergoing infrarenal abdominal aortic aneurysmectomy.. Abdominal aortic aneurysmectomy patients were randomly assigned to 1 of 3 groups (n = 15 for each group). They were infused with normal saline solution (SA), 0.02 microg/kg/min of HANP (LH), or 0.05 microg/kg/min of HANP (HH), starting 5 minutes after clamping. Hemodynamic variables were measured before/after clamping and unclamping.. Both mean pulmonary arterial pressure (MPAP) and the pulmonary vascular resistance index (PVRI) increased (v baseline) in the SA group. HANP attenuated the rises in MPAP and PVRI dose dependently (LH and HH groups v SA). Mean arterial pressure and systemic vascular resistance index were not significantly different among the 3 groups.. HANP, infused during aortic clamping and abdominal aortic aneurysmectomy, attenuates the rises in pulmonary artery pressure and vascular resistance without severe systemic hypotension. This may result from direct and/or indirect pulmonary vascular effects of HANP because no HANP-induced changes in endothelin-1, angiotensin-II, and thromboxane B(2) were detected.

Topics: Aged; Aged, 80 and over; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Blood Pressure; Dose-Response Relationship, Drug; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Peptide Fragments; Prospective Studies; Pulmonary Artery; Vascular Resistance; Vascular Surgical Procedures

Ischemia-reperfusion injury is an important cause of renal dysfunction after abdominal aortic aneurysm repair. Human atrial natriuretic peptide (hANP) is a potent endogenous natriuretic, diuretic, and vasorelaxant peptide. The objective of the present study was to evaluate the effects of hANP on renal function in patients undergoing abdominal aortic aneurysm repair.. A prospective, randomized, placebo-controlled study. Intensive care unit of a university hospital.. Forty patients undergoing elective abdominal aortic aneurysm repair.. The patients were randomized to receive a continuous infusion of either hANP (0.01-0.05 microg/kg/min) (n = 20) or placebo (n = 20) immediately before aortic cross-clamping. The infusion of hANP or placebo continued for 48 hrs.. Blood and urine samples were taken before surgery, at admission to the intensive care unit, and on days 1, 2, and 3 postoperatively, for measurement of serum concentrations of sodium, creatinine, and blood urea nitrogen and plasma concentrations of ANP and brain natriuretic peptide (BNP). Urine volume and urinary concentrations of N-acetyl-beta-D-glucosaminidase (NAG), sodium, and creatinine were also measured. The mean plasma concentration of ANP was significantly higher in the hANP group than in the placebo group. The mean plasma BNP concentration was significantly lower in the hANP group than in the placebo group. The mean serum concentrations of creatinine and blood urea nitrogen were significantly (p < .05) lower in the hANP group than in the placebo group. The mean urine volume and mean creatinine clearance were significantly (p < .05) higher in the hANP group than in the placebo group. The mean urinary NAG/creatinine ratio was significantly (p < .05) lower in the hANP group than in the placebo group.. The intraoperative and postoperative infusion of low-dose hANP preserved renal function in patients undergoing abdominal aortic aneurysm repair. Further studies are needed to assess the efficacy of prophylactic hANP infusion on perioperative renal outcome.

Topics: Aged; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Female; Humans; Kidney; Male; Prospective Studies

Delayed hypertension (HT) and renal dysfunction (RD) are observed after aortic operations accompanied by infra-renal aortic cross-clamping (AXC). Atrial natriuretic peptide (ANP) has effects on vasodilation and renal protection, and we examined the hypothesis that synthetic human alpha-ANP (hANP) improves the postoperative management for abdominal aortic aneurysm (AAA).. Fifty patients undergoing elective aneurysmectomy for infrarenal-AAA between 1998 and 2001 (M:F = 43:7, mean age 70.5 +/- 7.7 years) were randomly allocated to one of 2 groups; Group H (n = 24) received hANP immediately after operation (initial dose: 0.025 microg/kg/min), and Group C (n = 26) served as a control group.. All patients in Group C required nicardipine hydrochloride (4.41 +/- 1.68 mg/h) for prevention of postoperative HT, whereas only 6 patients in Group H required the increase in hANP dose due to HT (P < 0.0001). Maximum hANP dose was 0.035 +/- 0.019 microg/kg/min. Group H showed significantly smaller furosemide dosage in the initial 3 days (H vs. C; 9.2 +/- 11.0 vs. 58.8 +/- 41.5 mg, P < 0.0001), significantly lower peak-Crn (H vs. C; 1.16 +/- 0.53 vs. 2.58 +/- 1.42 mg/dL, P < 0.0001), and significantly lower plasma renin-activity (7.09 +/- 2.38 vs. 11.52 +/- 4.89 ng/mL/h, P = 0.0002) and aldosterone (51.6 +/- 12.7 vs. 81.2 +/- 34.2 pg/mL, P = 0.0002) on the first postoperative day than Group C did.. These results imply that renin-angiotensin system may play a role in the incidence of postoperative HT and RD, and suggest that hANP infusion is a simple, reliable, and effective method for management during the immediate period after AAA operations.

Topics: Aged; Aldosterone; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Chi-Square Distribution; Female; Humans; Hypertension; Kidney Diseases; Male; Middle Aged; Postoperative Complications; Renin

Hypertonic-hyperoncotic solutions (HHT) are presently being utilized to resuscitate patients in shock. However, so far, the effects of HHT on human atrial natriuretic factor (hANF) have not yet been investigated in a clinical trial. The effects of HHT on hANF were studied in a standardized preoperative and clinical setting in patients undergoing aneurysmectomy. Twenty-three conscious patients were included in two groups: 11 HHT and 12 HES (HHT: 7.5% NaCl/10% HES 200; HES: .9% NaCl/10% HES 200). Stepwise infusion of 50 mL was titrated preoperatively according to individual Frank-Starling relationships. Central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were determined before, during and after volume application. hANF, cGMP were also measured before and 1, 10, 30, 60, and 120 min after administration. The volumes necessary to produce the same volume status were: 213.6 +/- 63.6 mL of HHT, 409.9 +/- 136.2 mL of HES (p < .001). The sodium load was 273.9 +/- 81.5 mmol of [HHT], 63.1 +/- 21.0 mmol of [HES] (p < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Analysis of Variance; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Central Venous Pressure; Cyclic GMP; Double-Blind Method; Humans; Hypertonic Solutions; Infusions, Intravenous; Isotonic Solutions; Middle Aged; Plasma Volume; Pulmonary Wedge Pressure

Atrial natriuretic factor (ANF) is a peptide hormone released from atrial cardiocytes in response to atrial stretch. It has potent and selective effects on vascular smooth muscle, fluid and electrolyte balance, and may interact with other vasoactive substances. The influence of anaesthesia and major vascular surgery on the release and circulation of ANF is unknown. Therefore the relationships between haemodynamic variables, volume expansion and plasma ANF were studied in patients undergoing resection of abdominal aortic aneurysm, randomly assigned to receive isoflurane or propofol+fentanyl anaesthesia. The end point of anaesthetic regimens was the stabilization of mean arterial pressure between +/- 33% from baseline. Haemodynamic parameters and plasma ANF levels were measured preoperatively, after intubation, following aortic cross-clamping, 24 and 48 hours postoperatively. Because of well-known large degree in interpatient pharmacodynamic variability, anaesthesia with propofol and fentanyl did not ensure, usually, the established end point in dose ranges that did not produce unacceptable morbidity. ANF plasma levels were elevated during surgery and in the immediate postoperative period in both groups. A significant correlation was found between ANF levels and mean right atrial pressure. We concluded that anaesthetic drugs do not affect ANF release. Volume expansion for prevention of declamping shock increased, ANF from basal values, during surgery. Inadequacy of postoperative analgesia or persisting atrial stretch could explain the finding of high plasma levels during the immediate postoperative period.

Topics: Aged; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Fentanyl; Hemodynamics; Humans; Isoflurane; Male; Middle Aged; Propofol; Random Allocation

Pathogenesis of abdominal aortic aneurysm (AAA) is unclear. The aim of this study was to evaluate inflammatory and hemodynamic plasma biomarkers as predictors for AAA in the prospective longitudinal cohort of middle-aged individuals from the cardiovascular cohort of the Malmö Diet and Cancer Study ( n=5551; 1991-94). C-reactive protein, cystatin C, copeptin, N-terminal pro-B-type natriuretic peptide (N-BNP), midregional pro-atrial natriuretic peptide (MR-proANP) and conventional risk factors at baseline were measured in patients with incident AAA during follow-up and compared to individuals without a diagnosis of AAA. Subjects were followed until 31 December 2013. Multivariable analyses were expressed in terms of hazard ratios (HR) per 1 standard deviation increment of each respective log-transformed plasma biomarker in the Cox proportional hazard models. Mean follow-up time was 20.7 years. Cumulative incidence of AAA was 1.5% (men 2.9%, women 0.5%). Mean age of individuals with incident AAA was 59.7 years at study entry and AAA was diagnosed on average 14 years later. Adjusting for age, sex, smoking, body mass index, hypertension and diabetes mellitus, N-BNP (HR 1.29; 95% CI 1.03-1.62), but not MR-proANP (HR 1.20; 95% CI 0.95-1.50), was independently associated with incident AAA. In conclusion, the plasma biomarker N-BNP was associated with future development of AAA, which implies that this marker is a sensitive indicator of early subclinical cardiovascular disease.

Topics: Adult; Aged; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Biomarkers; Cardiovascular Diseases; Female; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors

Topics: Acute Kidney Injury; Aortic Aneurysm, Abdominal; Atrial Natriuretic Factor; Evidence-Based Medicine; Humans