atrial-natriuretic-factor and Coronary-Stenosis

To examine whether coronary artery stenosis affects plasma levels of atrial natriuretic peptide (ANP), N-terminal proatrial natriuretic peptide (proANP), and brain natriuretic peptide (BNP) in patients with normal left ventricular systolic function.. We studied 104 consecutive patients with normal left ventricular function and suspected coronary artery stenosis. Plasma natriuretic peptide levels were measured by immunoradiometric assays.. Plasma levels of ANP, N-terminal proANP, and BNP were higher in patients with (n = 65) than in those without (n = 39) coronary artery stenosis, whereas hemodynamic variables were similar. Patients who had coronary artery stenosis with only distal lesions (n = 36) had higher levels of all three natriuretic peptides than did patients with no coronary artery stenosis. N-terminal proANP levels were significantly higher in patients who had coronary artery stenosis with proximal lesions (n = 29) than in patients who had coronary artery stenosis with only distal lesions and those with no coronary artery stenosis. Multiple logistic regression analysis revealed that N-terminal proANP, but not ANP or BNP, was independently associated with coronary artery stenosis after adjusting for clinical and demographic variables (odds ratio per 100 fmol/mL increase = 1.9; 95% confidence interval: 1.9 to 2.6; P = 0.01). However, the sensitivity, specificity, and positive and negative predictive values of each peptide were not sufficiently high to be used for prediction.. N-terminal proANP may be associated with clinically important coronary artery stenosis in patients with normal left ventricular systolic function, but its clinical usefulness may be limited.

Topics: Atrial Natriuretic Factor; Cardiovascular Agents; Coronary Stenosis; Female; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Ventricular Function, Left

Natriuretic peptides (NPs) modulate vasodilatation and vascular remodelling. In human coronary explants, expression of NPs mRNA and their respective receptors is significantly more pronounced with advanced atherosclerotic lesions.. We hypothesize that vascular atherosclerosis modulates NP release in vivo during progressive stages of coronary atherosclerosis.. NT-proANP (A) and NT-proBNP (B) were assessed on blood samples of 194 patients. Coronary atherosclerosis was assessed in all patients by angiography and in case of moderate stenosis by fractional flow reserve (FFR), a validated tool for detecting ischemia-inducing stenosis. Significant coronary stenosis was defined as a diameter stenosis (DS) >/=50% and/or positive FFR. Endothelial dysfunction was detected by cold pressure test (CPT) in a subgroup of 99 patients. Patients were divided into: (1) normal group (normal endothelial function, n=19); (2) endothelial dysfunction group (n=17); (3) moderate atherosclerotic group (at least one coronary stenosis <50%, n=86); (4) stenotic group (n=72). A and B were higher in patients with endothelial dysfunction (A: 2951 [1290-3920] fmol/ml; B: 156 [98-170] pg/ml), moderate atherosclerotic (A: 3868 [2250-5890] fmol/ml, p<0.05 vs. normal; B: 162 [84-283] pg/ml) and stenotic group (A: 3934 [2647-5525]; B: 227 [191-784] pg/ml; p<0.05 vs. normal) as compared with normal group (A: 2378 [970-2601] fmol/ml; B: 78 [40-136] pg/ml). During CPT, a mild NT-proANP increase was observed only in patients with endothelial dysfunction (Delta% vs. baseline: 17+/-6, p<0.05). NT-proBNP did not change after CPT in all groups.. Well defined stages of atherosclerosis are characterized by progressive increases in NT-proANP and NT-proBNP levels, beginning with endothelial dysfunction and progressively more pronounced with moderate and severe coronary atherosclerosis irrespective of the underlying myocardial disease.

Topics: Atrial Natriuretic Factor; Cold Temperature; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Severity of Illness Index

Topics: Angina Pectoris; Angioplasty, Balloon, Coronary; Atrial Natriuretic Factor; Biomarkers; Coronary Restenosis; Coronary Stenosis; Half-Life; Humans; Myocardial Infarction; Myocardial Ischemia; Natriuretic Peptide, Brain; Outpatients; Protein Precursors; Systole; Ventricular Function, Left

Because of its unique storage and release mechanisms allowing a very rapid response to haemodynamic changes, pro-atrial natriuretic peptide (proANP) may be a helpful cardiac marker in the detection of myocardial ischaemia.. A total of 260 consecutive patients with suspected myocardial ischaemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography (SPECT) were enrolled. Levels of plasma proANP were determined before and 1 min after maximal exercise.. Baseline proANP and peak exercise proANP were significantly higher in patients with myocardial ischaemia as compared to those without ischaemia (median, 82 [IQR, 57-112] vs. 67 [IQR, 50-106] pmol L(-1), P = 0.007; and 89 [IQR, 65-121] vs. 78 [IQR, 57-116] pmol L(-1), P = 0.033). The area under the ROC curve for baseline proANP was 0.597 (95% CI, 0.527-0.667), as compared to 0.577 (95% CI, 0.507-0.648) for peak exercise proANP. Exercise-induced changes in proANP were similar in patients with and without myocardial ischaemia, and showed no correlation with the extent of myocardial ischaemia.. Baseline proANP and peak exercise proANP are significantly higher in patients with myocardial ischaemia. However, because of considerable overlap in proANP levels between patients with and without myocardial ischaemia, neither measurement seems helpful in the detection of myocardial ischaemia in clinical practice.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Coronary Angiography; Coronary Stenosis; Exercise; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Prospective Studies; ROC Curve; Stroke Volume; Tomography, Emission-Computed, Single-Photon

Topics: Angioplasty, Balloon, Coronary; Atrial Natriuretic Factor; Biomarkers; Coronary Restenosis; Coronary Stenosis; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Protein Precursors

Topics: Angina, Unstable; Atrial Natriuretic Factor; Coronary Stenosis; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis