atrial-natriuretic-factor and Mitral-Valve-Stenosis

Topics: Acute Kidney Injury; Animals; Atrial Natriuretic Factor; Blood Volume; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Heart Atria; Homeostasis; Humans; Kidney Failure, Chronic; Kidney Glomerulus; Mitral Valve Stenosis; Natriuresis; Pulmonary Circulation; Rats; Receptors, Atrial Natriuretic Factor; Receptors, Cell Surface

Accurate evaluation of the functional consequences of mitral stenosis (MS) can be difficult. The aim of this study was to evaluate the relationship between both atrial (ANP) and brain natriuretic peptides (BNP) and symptoms, exercise capacity and echocardiographic measures of MS severity.. Thirty patients with moderate to severe MS and 14 normal controls underwent clinical assessment, exercise stress echocardiography, measurement of ANP and BNP and two years follow up for clinical events.. BNP was higher in MS patients than controls (BNP 58 [IQR 34, 93] vs. 16 [14, 25], p < 0.0001). There was considerable overlap in exercise capacity and echocardiographic severity between asymptomatic and symptomatic patients. An increase in BNP was associated with a larger left atrial area index (r = 0.67, p < 0.0001), reduced mitral valve area (r = -0.38, p = 0.05) and higher resting pulmonary artery pressure (r = 0.47, p = 0.008). Increased BNP predicted lower treadmill exercise capacity (AUC = 0.82 [95% confidence interval 0.67, 0.97], p = 0.004), guideline criteria for intervention (AUC = 0.87 [0.74, 0.99], p = 0.006) and adverse events during follow up (AUC = 0.81 [0.64, 0.99], p = 0.03). Associations for ANP in general were similar but slightly weaker, and ANP did not provide additional predictive information to BNP.. BNP may improve risk stratification of patients with MS, particularly when symptoms are equivocal.

Topics: Adult; Aged; Atrial Natriuretic Factor; Biomarkers; Echocardiography; Female; Humans; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Predictive Value of Tests; Severity of Illness Index

With regard to a deficiency in atrial natriuretic peptide (ANP) secretion, the relationship between plasma ANP and left atrial diameter measured by echocardiography was examined and the efficacy of postoperative supplementation was evaluated.. (1) Ninety-six patients with mitral valve disease from 1997 to 2002 (M:F = 65:31, mean-age 65.3 +/- 8.9 years) were studied for relationship analyses. (2) Twenty-six patients with mitral stenosis and left atrial diameter > or = 60 mm undergoing mitral valve replacement (M:F = 17:9, mean-age 67.4 +/- 7.5 years) were randomly allocated to one of two groups; ANP-treated group (n = 13, 0.05 microg/kg/min of synthetic human alpha-ANP was postoperatively administered) and Control group (n = 13).. (1) There were significant positive correlations between left atrial diameter and plasma renin-activity (r = 0.690, P < 0.01) and between left atrial diameter and plasma aldosterone (r = 0.757, P < 0.01). The maximum value of plasma ANP was 249.5 pg/mL accompanied with 56.2 mm of left atrial diameter in 29 patients suffering from mitral stenosis. There was a significant negative correlation between left atrial diameter and ANP in patients with left atrial diameter > 56.2 mm (r = - 0.725, P < 0.0001), whereas there was a significant positive correlation in patients with left atrial diameter < or = 56.2 mm (r = 0.529, P = 0.0066). (2) At 24 hours after operation, the ANP-treated group showed significantly lower plasma renin-activity (9.2 +/- 3.3 versus 36.2 +/- 7.4 ng/mL/h) and aldosterone (113.6 +/- 36.9 versus 473.8 +/- 95.8 pg/mL) than the Control group.. Left atrial diameter can be a simple and useful indicator of a deficiency in endogenous ANP secretion in patients with mitral stenosis, and postoperative ANP supplementation contributes to suppressing further activation of renin-angiotensin system during the immediate postoperative period.

Topics: Aged; Atrial Natriuretic Factor; Female; Heart; Heart Atria; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Infusions, Intravenous; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Care; Ultrasonography

Biological activity of endogenous atrial natriuretic peptide (ANP) may decrease during cardiopulmonary bypass. To evaluate the effects of intraoperative administration of exogenous ANP in patients undergoing cardiopulmonary bypass, we conducted a prospective randomized study.. Eighteen patients undergoing mitral valve surgery were randomized to receive either ANP treatment (ANP group; n = 9) or no ANP treatment (control group; n = 9). Atrial natriuretic peptide was given immediately after initiation of cardiopulmonary bypass for 6 hours (0.05 microg x kg(-1) x min(-1)). Plasma ANP, brain natriuretic peptide and cyclic guanosine monophosphate (cGMP) levels, hemodynamic variables and renal function were assessed perioperatively.. Administration of ANP increased plasma cyclic guanosine monophosphate levels, urine output and fractional sodium excretion, and decreased preload, afterload and plasma brain natriuretic peptide levels significantly (p < 0.05). Plasma cyclic guanosine monophosphate levels correlated with plasma ANP levels (r = 0.95, p = 0.0001), correlated with fractional sodium excretion (r = 0.53, p = 0.02), and correlated inversely with systemic vascular resistance (r = -0.54, p = 0.02).. Intraoperative administration of ANP had potent effects on natriuresis and systemic vasodilation by elevating cyclic guanosine monophosphate levels. The results suggest that the technique is useful for the management of hemodynamics and water-sodium retention after cardiopulmonary bypass.

Topics: Adult; Aged; Atrial Natriuretic Factor; Cardiopulmonary Bypass; Cyclic GMP; Diuretics; Female; Heart Valve Prosthesis Implantation; Humans; Intraoperative Period; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Natriuresis; Peptide Fragments; Prospective Studies; Vasodilation

The effect of hANP (atrial natriuretic peptide) was investigated clinically in 40 patients who underwent isolated valve replacement. Patients were divided into four groups: aortic regurgitation (AR), aortic stenosis (AS), mitral regurgitation (MR) and mitral stenosis (MS). Each group was divided into two subgroups: one was administered hANP after the operation until leaving ICU, and the other was not administered hANP. We measured the levels of hANP and c-GMP and blood pressure, pulmonary artery pressure, central venous pressure and levels of Na, K of urine and blood prcoperatively, immediately postoperatively and 1, 2, 4, 6 hours after operation. First, to examine the relationship between preoperative level of hANP and cardiac function, the relationship between preoperative level of hANP and history of cardiac failure and pulmonary artery wedge pressure (PAWP) were evaluated. Also, we evaluated the relationship between preoperative level of hANP and each dimension on echocardiography. There was a weak statistical relationship between hANP and PAWP (row = 0.39 (p = 0.04) Pearson correlation method) and there was no statistical relationship between hANP and duration of cardiac failure (row = 0.00445 (p = 0.98) Pearson correlation method). Preoperatively Left atrial diameter (LAD) showed a statistical relationship with level of hANP in every group using Spearman correlation method. Other dimensions such as left ventricular diastolic diameter (LVDd) and left ventricular systolic diameter (LVDs) and also fractional shortening (FS) did not show a strong correlation with preoperative level of hANP. Especially, in AS group there was a strong relationship between every dimension and preoperative level of hANP. Only in MS group LAD and the level of hANP were negatively related. This finding suggests that atrial dilatation results in reduction of secretion of hANP in cases of MS on long term follow up. Finally, hNAP therapy was shown to have a continuous diuretic effect, with stable hemodynamics.

Topics: Adult; Aortic Valve Insufficiency; Aortic Valve Stenosis; Atrial Natriuretic Factor; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pulmonary Wedge Pressure

To clarify the factors that influenced the secretion of human atrial natriuretic peptide (ANP) during exercise, we studied the relations between the changes in ANP, transmitral pressure gradient, heart rate and blood pressure at exercise in 16 patients with mitral stenosis before and after percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, ANP levels increased from 107 +/- 70 to 183 +/- 96 pg/ml during exercise testing (p less than 0.01), concomitant with the increment in mean transmitral pressure gradient, heart rate and systolic blood pressure. After PTMC, ANP levels also increased from 78 +/- 43 to 117 +/- 64 pg/ml, concomitant with the increment of those parameters. However, increments of ANP, mean transmitral pressure gradient and heart rate after PTMC were lower than those before PTMC. Because the most important factor influencing the secretion of ANP was unclear, the differences between these parameters were calculated at submaximal exercise before and after PTMC. There was a significant relation only between the change in ANP and mean transmitral pressure gradient (r = 0.70, p less than 0.01). These results suggest that the most important factor influencing the secretion of ANP during exercise is the change in transmitral pressure gradient in patients with mitral stenosis.

Topics: Atrial Natriuretic Factor; Catheterization; Exercise; Exercise Test; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis

We studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146 (sCD146), in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success.. Biomarkers were tested in 40 patients the day before and the day after PMC. Success was defined as mitral valve area ≥ 1.5 cm. Average age was 63.5 ± 12.7 years; 32(80%) were female. Before PMC, mean valve area was 1.1 ± 0.2 cm. MR-proANP and plasma sCD146 decreased significantly immediately after successful PMC. They appear to be markers of immediate success of PMC and of the hemodynamic improvement achieved by this procedure in patients with MS.. This study is part of the cohorts registered with ClinicalTrials.gov on June 16, 2011 under the number NCT01374880.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Cardiac Surgical Procedures; CD146 Antigen; Female; Humans; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Paris; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Recovery of Function; Severity of Illness Index; Time Factors; Treatment Outcome

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; CD146 Antigen; Echocardiography; Female; France; Humans; Hypertension, Pulmonary; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Prospective Studies; Severity of Illness Index

Previous reports indicate that plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) increase in atrial fibrillation (AF), but decrease after successful direct current (DC) cardioversion. Although the maze procedure is the only curative therapy for AF, the effects on atrial and left ventricular function remain unclear. The study aim was to determine whether plasma ANP and BNP levels decrease after the maze procedure in patients with mitral valve disease.. Twenty-seven patients either with (n = 23) or without (n = 4) AF underwent mitral valve surgery; of these patients, 13 underwent a maze procedure for chronic AF. Blood samples and echocardiographic data were obtained before and at one year after surgery.. Ten patients with AF achieved sinus rhythm (SR) or junctional rhythm after the maze procedure. In patients subjected to mitral valve surgery, mean plasma levels of ANP and BNP were 59.8 +/- 11.9 and 139.2 +/- 53.7 pg/ml, respectively. ANP and BNP plasma levels fell significantly after surgery (to 32.1 +/- 4.1 and 46.7 +/- 10.2 pg/ml, respectively; p = 0.04 and p = 0.004). In patients with successful maze procedure, plasma levels of BNP and left ventricular end-diastolic dimension (LVDd) were significantly decreased by 35.7% and 82.7% compared with preoperative values (BNP, 35.7 +/- 4.9% for SR versus 83.4 +/- 9.6% for AF, p = 0.008; LVDd, 82.7 +/- 3.7% for SR versus 97.0 +/- 3.2% for AF, p = 0.0159).. A successful maze procedure significantly decreased LVDd and plasma levels of BNP after surgery. These results show that the maze procedure is effective in improving left ventricular diastolic dysfunction for a mid-term period in patients with mitral valve disease.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Chronic Disease; Cohort Studies; Electric Countershock; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Probability; Prognosis; Regression Analysis; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome

The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients in sinus rhythm (SR) and with atrial fibrillation (AF). The study aim was to evaluate the effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis in SR and AF.. Thirty-one patients (26 females, five males; mean age 50.5+/-14 years) with pure rheumatic mitral stenosis underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting in a supine position for > or =2 h. Digitalis and diuretics were withdrawn 48 h before sampling; neither had patients received ACE inhibitors or beta-blockers during the previous month.. PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index was increased in both groups, but was distinctly lower in AF patients both before and after PBMV.. Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, most likely because in AF patients a low cardiac index elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR.

Topics: Adolescent; Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Catheterization; Echocardiography; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Neurotransmitter Agents; Renin; Treatment Outcome; Ventricular Function, Left

Topics: Administration, Oral; Atrial Natriuretic Factor; Cardiopulmonary Bypass; Female; Heart Failure; Humans; Infusions, Intravenous; Middle Aged; Mitral Valve Stenosis; Postoperative Care; Spironolactone; Tricuspid Valve Insufficiency

The present report concerns a case of very low plasma levels of atrial natriuretic peptide (ANP) accompanying severe pulmonary hypertension due to mitral stenosis. There was remarkable fibrosis in the atrium and ANP secretion may have been insufficient. Low-dose infusion (0.025 microg kg(-1) min(-1)) of synthetic human alpha-ANP infusion was very effective in improving the pulmonary hypertension.

Topics: Atrial Natriuretic Factor; Heart Failure; Humans; Hypertension, Pulmonary; Infusions, Intravenous; Male; Middle Aged; Mitral Valve Stenosis; Pulmonary Wedge Pressure; Time Factors

Recently, combined treatment using the Maze procedure for organic heart disease and atrial fibrillation has been reported, but there have been few studies of cardiac rhythm after combined treatment. Predictors of cardiac rhythm after combined surgical treatment have been unknown.. Thirty patients who underwent cardiac surgery with the Maze procedure were retrospectively enrolled in this study. Two groups consisted of the patients with restoration of sinus rhythm after surgery (SR: n=15, 6 males and 9 females, mean age of 64 years), and the patients with maintenance of atrial fibrillation (AF; n=15, 5 males and 10 females, mean age of 61 years). Before cardiac surgery, all patients underwent exercise testing with measurement of atrial natriuretic peptide (ANP) before and after exercise testing, two-dimensional echocardiography, and right and left heart catheterization.. The mean maximal heart rate and the ANP level after exercise testing in SR were significantly higher than those in AF. The left atrial dimension and right atrial and pulmonary capillary wedge pressures were significantly higher in AF than in SR. These findings indicate that subjects in SR exhibited less impaired atrial function which were evaluated by exercise testing with measurement of ANP, echocardiography, and cardiac catheterization.. The atrial function of patients with sinus rhythm after the Maze procedure may be less impaired than that of patients remaining in atrial fibrillation.

Topics: Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Combined Modality Therapy; Electrocardiography; Exercise Test; Female; Heart Atria; Heart Septal Defects, Atrial; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Complications; Retrospective Studies; Suture Techniques; Treatment Outcome

Topics: Atrial Natriuretic Factor; Cardiomegaly; Female; Heart Atria; Humans; Middle Aged; Mitral Valve Stenosis; Oliguria; Postoperative Complications; Tricuspid Valve Insufficiency

To examine the pathophysiological significance of adrenomedullin in the pulmonary circulation by investigating the relation between plasma concentrations of adrenomedullin and central haemodynamics in patients with mitral stenosis.. Plasma concentrations of adrenomedullin in blood samples obtained from the femoral vein, pulmonary artery, left atrium, and aorta were measured by a newly developed specific radio-immunoassay in 23 consecutive patients with mitral stenosis (16 females and seven males, aged 53 (10) years (mean (SD)) who were undergoing percutaneous mitral commissurotomy.. Patients with mitral stenosis had higher concentrations of adrenomedullin than age matched normal controls (3.9 (0.3) v 2.5 (0.3) pmol/l, p < 0.001). There was a reduction in adrenomedullin concentrations between the pulmonary artery and the left atrium (3.8 (0.2) v 3.2 (0.4) pmol/l, p < 0.001). The venous concentrations of adrenomedullin correlated with mean pulmonary artery pressure (r = 0.65, p < 0.001), total pulmonary vascular resistance (r = 0.83, p < 0.0001), and pulmonary vascular resistance (r = 0.65, p < 0.001). Plasma concentrations of adrenomedullin did not change immediately after percutaneous mitral commissurotomy; however, they decreased significantly one week later.. Plasma concentrations of adrenomedullin are increased in patients with mitral stenosis. This may help to attenuate the increased pulmonary arterial resistance in secondary pulmonary hypertension due to mitral stenosis.

Topics: Adrenomedullin; Adult; Aged; Atrial Natriuretic Factor; Biomarkers; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptides; Pulmonary Circulation; Vascular Resistance

To clarify whether myocardial adrenergic activity is different in patients with heart failure without left ventricular volume or pressure overload, we used iodine-123 metaiodobenzylguanidine (MIBG) imaging to study patients with mitral stenosis.. In patients with heart failure due to cardiomyopathy or to valve diseases with volume or pressure overload, or both, myocardial adrenergic nerve activity is accelerated independent of underlying cause. However, it is not clear whether this change in myocardial adrenergic nerve activity is present in patients without left ventricular volume or pressure overload.. The study patients were 20 men and women with normal left ventricular function and heart failure due to mitral stenosis. Planar MIBG images obtained from these patients were compared with images from nine age-matched healthy subjects (control group). Myocardial uptake of MIBG was calculated as the heart/mediastinal activity ratio. Storage and release of MIBG were calculated as percent myocardial MIBG washout from 15 min to 4 h after isotope injection. All 20 study patients underwent echocardiography, and 16 underwent right heart catheterization.. The heart/mediastinal activity ratio in the immediate images (15 min) did not show any significant difference between the patient and control groups. Myocardial washout was increased in patients with severe heart failure. The level of myocardial washout correlated with left atrial diameter (r = 0.51, p = 0.02) and mitral valve area calculated with Doppler echocardiography (r = -0.61, p < 0.01) and mitral valve area calculated with cardiac catheterization (r = -0.62, p = 0.02). The closest correlation existed between myocardial washout and cardiac output (r = -0.80, p < 0.01).. In heart failure due to mitral stenosis, myocardial adrenergic nerve activity is intensified. A decrease in cardiac output associated with mitral stenosis acts as a potent stimulus for this intensification.

Topics: 3-Iodobenzylguanidine; Atrial Natriuretic Factor; Cardiac Catheterization; Cardiac Output; Case-Control Studies; Contrast Media; Echocardiography, Doppler; Female; Heart; Heart Failure; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Mitral Valve Stenosis; Norepinephrine; Radionuclide Imaging; Sympathetic Nervous System; Time Factors; Ventricular Function, Left; Ventricular Pressure

This study was designed to determine whether plasma brain natriuretic peptide (BNP) increases in response to exercise in patients with congestive heart failure and to show what kind of hemodynamic abnormalities induce increased secretion of BNP during exercise. Plasma levels of atrial natriuretic peptide (ANP) and BNP and hemodynamic parameters were measured during upright bicycle exercise tests in seven patients with dilated cardiomyopathy and nine with mitral stenosis. At rest, there were no intergroup differences in cardiac output or pulmonary capillary wedge pressure; however, the group with dilated cardiomyopathy had higher left ventricular end-diastolic pressures and lower left ventricular ejection fractions than did the group with mitral stenosis. Plasma ANP levels were comparable between the dilated cardiomyopathy group (170 +/- 77 [SE] pg/ml) and the mitral stenosis group (106 +/- 33 pg/ml) (p, not significant), whereas BNP was significantly higher in the dilated cardiomyopathy group (221 +/- 80 pg/ml) than in the other group (37 +/- 10 pg/ml) (p < 0.05). The plasma concentration of BNP but not of ANP significantly correlated with left ventricular end-diastolic pressure and volume. Exercise increased plasma ANP and BNP in the two groups. The dilated cardiomyopathy group had a larger increment in BNP (+157 +/- 79 pg/ml) than did the mitral stenosis group (+17 +/- 5 pg/ml) (p < 0.05), although the increase in pulmonary capillary wedge pressure was greater in the mitral stenosis group. Thus exercise increases plasma levels of BNP, and impaired left ventricular function may be a main factor in the greater increment in BNP during exercise in patients with congestive heart failure.

Topics: Atrial Natriuretic Factor; Cardiomyopathy, Dilated; Catheterization, Peripheral; Exercise; Exercise Test; Heart Failure; Hemodynamics; Humans; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Statistics, Nonparametric; Ventricular Dysfunction, Left

1. In order to appreciate the effect of changes in left atrial pressure on plasma brain natriuretic peptide, 20 patients with mitral stenosis treated by percutaneous valvulotomy were studied 10 min before and 15 min after the first balloon inflation. They were also studied 24 h before and 48 h after the valvulotomy. At these times the effect of postural changes on brain natriuretic peptide secretion was examined. A group of 10 control subjects was also studied under basal conditions. In each case, plasma atrial natriuretic peptide was measured in parallel with plasma brain natriuretic peptide. 2. Similarly to plasma atrial natriuretic peptide, plasma brain natriuretic peptide was elevated in patients with mitral stenosis (32 +/- 2.9 and 32 +/- 2.8 pg/ml in the upright and supine position respectively versus 13.5 +/- 0.5 and 13.8 +/- 1.8 pg/ml in controls; P < 0.01). Changing from standing to lying did not modify plasma brain natriuretic peptide, whereas it produced an increase in plasma atrial natriuretic peptide in controls (13.3 +/- 1.6 versus 24.8 +/- 5.2 pg/ml; P < 0.01) and in patients 48 h after valvulotomy (52.5 +/- 4.6 versus 66.9 +/- 6.6 pg/ml; P < 0.01). Plasma brain natriuretic peptide also fell at this time (18.8 +/- 1.1 and 19.1 +/- 1.1 pg/ml in the upright and supine position respectively; P < 0.01) similarly to plasma atrial natriuretic peptide and cyclic GMP (P < 0.01). The acute left atrial mean pressure variation was significantly correlated with the parallel change in plasma atrial natriuretic peptide (P < 0.001) but not in plasma brain natriuretic peptide.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Atrial Natriuretic Factor; Catheterization; Female; Humans; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Posture; Time Factors

The recent introduction of percutaneous transvenous mitral valvuloplasty (PTMV) for the treatment of mitral stenosis (MS) has provided a unique human model for the study of short-term changes in ANF secretion before and after a reduction in left atrial pressure. This study was designed to investigate the effect of a short-term reduction in left atrial pressure and volume, as determined by echocardiographic study, on ANF and other neurohumoral factor plasma levels (renin and aldosterone).. 10 patients in III FC NYHA, with normal sinus rhythm and MS underwent PTMV. Hemodynamic parameters were measured immediately before and after (20-30 minutes) PTMV. Plasma levels of ANF, aldosterone and plasma renin activity (PRA) were obtained before (24 h) and after (2 h and 24 h) valvuloplasty; echocardiographic left atrial size before (24 h) and 24 h after PTMV.. Immediately after PTMV mean left atrial (LA) pressure decreased from 22.3 +/- 6.8 mmHg to 10.0 +/- 2.4 mmHg (p < 0.01); mitral valve area (MVA) increased from 0.99 +/- 0.28 cm2 to 2.17 +/- 0.26 cm2 (p < 0.01). 24 hours after PTMV on echocardiography, LA systolic volume decreased from 59.5 +/- 16.9 cm3 to 42.3 +/- 8.3 cm3 (p < 0.01), LA diastolic volume from 82.6 +/- 15.8 cm3 to 66.5 +/- 12.6 cm3 (p < 0.01), and LA diameter from 48.1 +/- 7.5 mm to 39.2 +/- 4.4 mm (p < 0.01). ANF plasma levels before PTMV were 64.0 +/- 36.9 fmol/ml; 2 and 24 hours after PTMV they fell to 34.2 +/- 21.6 fmol/ml (p < 0.01) and to 20.3 +/- 21.0 fmol/ml (p < 0.01), respectively. PRA values were 15.7 +/- 13.2 ng/ml/h before PTMV; 2 and 24 hours after PTMV they increased to 17.5 +/- 23.2 ng/ml/h (NS) and to 22.3 +/- 16.8 ng/ml/h (p < 0.01). The aldosterone plasma levels were 43.2 +/- 27.9 ng/dl before PTMV and 47.3 +/- 35.8 ng/dl (NS) and 45.3 +/- 28.0 ng/dl (NS) 2 and 24 hours after PTMV.. These results indicate that LA "de-stretching" due to the MVA increase and LA pressure decrease, leads to an abrupt reduction of ANF secretion. According to other studies, PRA increases immediately after PTMV, with a further increase 24 hours after PTMV.

Topics: Adult; Atrial Natriuretic Factor; Cardiac Catheterization; Catheterization; Circadian Rhythm; Echocardiography; Female; Hemodynamics; Humans; Linear Models; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Rheumatic Heart Disease; Time Factors

The role of left atrial and aortic pressures on the secretion of the main hormones controlling blood volume is still subject to debate in humans. Because of increased mean left atrial pressure and decreased mean aortic pressure produced by balloon inflation in patients with mitral stenosis treated with balloon valvulotomy, the hormonal changes occurring acutely (group II of patients) were measured. The same studies (group I patients) were also performed 48 hours after this treatment, a period at which left atrial pressure permanently diminished. Inflation of the balloon resulted in a decrease in plasma renin activity and increases in plasma atrial natriuretic factor (ANF) and plasma arginine vasopressin (AVP). Forty-eight hours after balloon valvulotomy, which had produced a decrease in left atrial pressure, plasma ANF was lower (58.9 +/- 7.9 vs 95.3 +/- 11.9 pg/ml; p < 0.001), and plasma renin activity (2,575 +/- 533 vs 960 +/- 113 pg/ml/hour; p < 0.01), plasma angiotensin II (25.0 +/- 4.1 vs 9.3 +/- 1.3 pg/ml; p < 0.001) and plasma aldosterone (181.7 +/- 36.7 vs 139.9 +/- 19.8 pg/ml; p < 0.05) were higher than their respective control levels 24 hours before treatment of the stenosis. In contrast, plasma AVP (3.7 +/- 0.25 vs 4.4 +/- 0.31 pg/ml; p = 0.001) diminished moderately along with plasma osmolality (282.4 +/- 0.1 vs 286.2 +/- 0.6 mOsm/kg; p < 0.001). Urinary sodium excretion was also examined before and after balloon valvulotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aldosterone; Angiotensin II; Aorta; Arginine Vasopressin; Atrial Function, Left; Atrial Natriuretic Factor; Blood Pressure; Cardiac Output; Catheterization; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Osmolar Concentration; Pulmonary Artery; Renin; Sodium; Time Factors

Plasma levels of both atrial natriuretic peptide (ANP) and cyclic GMP are elevated in patients with various heart diseases as compared to healthy subjects. In this study patients with advanced mitral valve disease (Group A) and healthy subjects (Group B) were exposed to symptom-limited upright stepwise physical exercise on a cycle ergometer. Concentrations of ANP and cyclic GMP were measured in plasma at rest (20 min in supine position) or 5 min after physical exercise by specific radioimmunoassays. Here we show that short dynamic exercise caused a significant increase in plasma levels of ANP and cyclic GMP, in both groups. In Group A strong correlation between plasma ANP and cyclic GMP was found at rest (r = 0.91, P < 0.001, n = 11) and after physical exercise (r = 0.85, P < 0.001, n = 11). In contrast, there was no correlation between plasma concentrations of ANP and cyclic GMP in Group B at rest (r = -0.16, P > 0.05, n = 10) or after exercise loading (r = 0.14, P > 0.05, n = 10). Absolute increases in circulating levels of both substances were not found to correlate in either group. These data suggest that exercise-induced elevations in plasma cyclic GMP may be due not only to ANP release but also to an as yet undetermined factor, possibly EDRF/NO.

Topics: Adult; Atrial Natriuretic Factor; Cyclic GMP; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Nitric Oxide; Reference Values

The purpose of this study was to evaluate the effect of direct current cardioversion therapy on the plasma concentration of atrial natriuretic peptide and to determine the main factors that influence the change in plasma atrial natriuretic peptide levels in patients with atrial fibrillation.. In atrial arrythmias, whether the fast atrial rate itself or the associated elevation of atrial pressure, or both, contributes to the increase in atrial natriuretic peptide is a subject of debate.. In 15 patients with mild mitral stenosis, plasma atrial natriuretic peptide levels were measured and transmitral flow pattern was obtained by continuous wave Doppler echocardiography immediately before cardioversion and at 5 min, 4 h, 24 h and 5 days after direct current cardioversion. Mean mitral pressure gradient and atrial filling fraction were calculated on the basis of transmitral flow.. In three patients who did not have a successful return to sinus rhythm, plasma atrial natriuretic peptide levels remained elevated after cardioversion. In 12 patients who maintained sinus rhythm, plasma atrial natriuretic peptide levels were significantly reduced from 79 +/- 29 to 36 +/- 11 pg/ml 4 h after cardioversion to sinus rhythm. However, the mitral pressure gradient did not change significantly during the observation period. There were progressive increases in atrial filling fraction throughout the observation period. From 4 h to 5 days after direct current cardioversion, plasma atrial natriuretic peptide levels gradually increased concomitantly with the recovery of atrial mechanical function.. The reduction of plasma atrial natriuretic peptide levels after direct current cardioversion might be due to recovery from the high rate of atrial firing and not to an alteration in the mitral pressure gradient. Direct current cardioversion itself does not seem to influence atrial natriuretic peptide secretion. The increase in atrial natriuretic peptide levels from 4 h to 5 days after cardioversion concomitantly with an increase in atrial filling fraction may be due to recovery of atrial mechanical function.

Topics: Adult; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Blood Flow Velocity; Echocardiography, Doppler; Electric Countershock; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis

Atrial natriuretic peptide (ANP) has been reported to have protective effects against methacholine-induced bronchoconstriction in asthmatics. The aim of the study was to evaluate the relationship between plasma ANP levels and bronchial responsiveness to methacholine in patients with mitral stenosis. In 12 patients with moderate mitral stenosis, age 35-58 years, 9 female, 8 in NYHA class 2, 4 in NYHA class 3 for symptoms, plasma ANP and bronchial threshold to methacholine (PD20FEV1) were determined. The same measurements were performed in 10 asthmatic patients, hyperresponsive to methacholine, and in 10 normal subjects, nonresponsive to methacholine. Mean +/- SE plasma ANP levels were significantly higher in patients with mitral stenosis in comparison with asthmatics and normals (159 +/- 41.8, 7.3 +/- 0.98, 7.6 +/- 1.3, respectively, p < 0.01). In patients with mitral stenosis there was a significant relationship between plasma ANP and PD20FEV1 (r = 0.81, p < 0.01). No relationship was found between ANP and PD20FEV1 in asthmatics. In conclusion, in patients with mitral stenosis ANP seems to play a protective role against bronchial hyperresponsiveness to methacholine.

Topics: Adult; Asthma; Atrial Natriuretic Factor; Bronchial Hyperreactivity; Bronchial Provocation Tests; Female; Humans; Male; Methacholine Chloride; Middle Aged; Mitral Valve Stenosis

The plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are increased in relation to the severity of congestive heart failure (CHF). This study was designed to examine whether the secretion patterns of ANP and BNP vary with underlying cardiac disorders of CHF with different degrees of overload in atria and ventricles.. We measured plasma levels of ANP and BNP in the aorta in 20 patients with mitral stenosis (MS) in whom atria are mainly overloaded, 30 patients with dilated cardiomyopathy (DCM) in whom both atria and ventricles are overloaded, and 20 control subjects during cardiac catheterization. Pulmonary capillary wedge pressure (PCWP) was significantly higher in the MS and DCM groups (16.7 +/- 4.7 mm Hg and 15.1 +/- 7.7 mm Hg, respectively) than in the control group (7.2 +/- 1.1 mm Hg, p < 0.01), whereas there was no significant difference between the MS and DCM groups. Left ventricular end-diastolic pressure (LVEDP) was significantly higher in the DCM group than in the MS group (16.4 +/- 7.8 mm Hg versus 7.6 +/- 2.0 mm Hg, p < 0.01), and the level was comparable between the MS and control groups (7.6 +/- 2.0 mm Hg versus 6.8 +/- 1.2 mm Hg, p = NS). The plasma ANP level was significantly higher in the MS and DCM groups (356 +/- 169 pg/ml and 331 +/- 323 pg/ml, respectively) than in the control group (98 +/- 41 pg/ml, p < 0.01), whereas there was no significant difference between the MS and DCM groups. The plasma BNP level was significantly higher in the DCM group than in the MS group (333 +/- 405 pg/ml versus 147 +/- 54 pg/ml, p < 0.01), and the level was significantly higher in the MS group than in the control group (147 +/- 54 pg/ml versus < 10 pg/ml, p < 0.01). The plasma levels of ANP and BNP had a highly positive correlation with PCWP in the DCM group (p < 0.01). On the other hand, in the MS group, the plasma ANP level had a highly significant correlation with PCWP (p < 0.01) but the plasma BNP level did not.. We conclude that plasma levels of BNP mainly reflect the degree of ventricular overload and that the secretion patterns of ANP and BNP vary with underlying cardiac disorders of CHF with different degrees of overload in atria and ventricles.

Topics: Adult; Aged; Atrial Natriuretic Factor; Cardiomyopathy, Dilated; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Radioimmunoassay; Regression Analysis

Brain natriuretic peptide (BNP), a family of peptides with structural and biologic homologies to previously identified atrial natriuretic peptide (ANP), has been found in human cardiac tissue and plasma. To examine the secretion mechanism of these peptides, we have studied the relationship between their plasma concentrations and hemodynamic parameters before and at 0.5 and 24 hours after percutaneous transvenous mitral commissurotomy (PTMC) in 14 patients with mitral stenosis. We have also investigated the validity of measuring plasma natriuretic peptides as a means for estimating changes in hemodynamic parameters after PTMC. The procedure decreased left atrial pressure (p < 0.01) with an elevation in left ventricular end-diastolic pressure (p < 0.05). Plasma ANP levels decreased significantly after PTMC (before, 64.1 +/- 33.7 fmol/ml; at 0.5 hour, 58.9 +/- 27.7 fmol/ml; at 24 hours, 45.7 +/- 18.3 fmol/ml; p < 0.01), whereas plasma BNP levels remained unchanged after the procedure (before, 5.3 +/- 1.5 fmol/ml; at 0.5 hour, 5.6 +/- 1.9 fmol/ml; at 24 hours, 5.0 +/- 1.9 fmol/ml; p = NS). There was a significant relationship between basal plasma ANP and left atrial pressure (r = 0.88; p < 0.001), and changes in plasma ANP were correlated with those in left atrial pressure (r = 0.69; p < 0.01). Basal plasma BNP was significantly correlated with basal left ventricular end-diastolic pressure (r = 0.65; p < 0.05) but not with the other measured hemodynamic parameters or with plasma volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Atrial Natriuretic Factor; Blood Pressure; Female; Heart Atria; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Natriuretic Peptide, Brain; Nerve Tissue Proteins

To evaluate direct secretion from the left atrium and pulmonary extraction of human atrial natriuretic peptide (hANP), we measured plasma hANP levels in the pulmonary artery, pulmonary vein, and left atrium in patients with either mitral stenosis or atrial septal defect. Left atrial pressure in patients with mitral stenosis was significantly higher than that in patients with atrial septal defect (7.5 +/- 1.0 mm Hg vs 3.1 +/- 0.5 mm Hg, p less than 0.01). The significant increase in the hANP level in the left atrium was recognized only in patients with mitral stenosis (149 +/- 33 pg/ml in the left atrium vs 130 +/- 28 pg/ml in the pulmonary vein, p less than 0.05). The plasma hANP level in the pulmonary vein was significantly lower than that in the pulmonary artery in both patients with mitral stenosis and those with atrial septal defect, which suggests that hANP is extracted in the lung. We conclude that hANP is secreted not only through the coronary sinus but also directly from the left atrium, stimulated by high left atrial pressure, and that circulating hANP is partially extracted in the pulmonary circulation.

Topics: Adult; Atrial Natriuretic Factor; Cardiac Catheterization; Female; Heart Atria; Heart Septal Defects, Atrial; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Pulmonary Artery; Pulmonary Veins; Radioimmunoassay

We determined the time-course of the release of atrial natriuretic factor (ANF) during cardiopulmonary bypass (CPB) in six patients undergoing coronary artery bypass (CAD) and eight patients undergoing valve replacement for mitral stenosis (MS). Before CPB, the arterial ANF was significantly higher in MS patients than in CAD patients (243 +/- 38 and 29 +/- 5.8 pg/ml respectively, P less than 0.01). With the onset of CPB, the acute pressure unloading of the atria induced a significant, rapid decrease of ANF only in MS patients (-64% of pre-CPB value at 5 min) and no major changes in CAD patients. Clamping of the aorta induced a further progressive reduction of ANF release to almost zero in both groups. Readmission of coronary flow to the empty atria with declamping resulted in an increase in the plasma level of ANF in both groups to reach the concentration present in MS patients before CPB. After CPB, the ANF levels decreased in CAD patients while remaining elevated in MS patients. These data suggest that ANF release from human atria depends on atrial filling pressure and other unknown factors.

Topics: Adult; Aged; Atrial Natriuretic Factor; Cardiopulmonary Bypass; Coronary Disease; Female; Heart Valve Prosthesis; Hemodynamics; Humans; Intraoperative Complications; Male; Middle Aged; Mitral Valve Stenosis; Myocardial Reperfusion Injury; Postoperative Complications; Reference Values; Saphenous Vein

Aim of this study was to evaluate if captopril treatment may directly alter the trial natriuretic factor (ANF) concentration. Six patients (2 male and 4 female) aged 53 +/- 11 years, with mitral stenosis, and atrial fibrillation, underwent cardiac catheterization in our Institution. The following parameters were evaluated: heart rate, right atrial and pulmonary capillary wedge pressure, aortic and pulmonary pressure, cardiac index, pulmonary and systemic resistances and ANF concentration in coronary sinus, pulmonary, artery, aorta, peripheral vein. All these parameters were measured before and 30 and 60 min after captopril administration (50 mg orally). No hemodynamic changes occurred after captopril administration. No changes in ANF concentration occurred in comparison with baseline levels, after 30 and 60 min in coronary sinus (199.8 +/- 151.5 vs 181.9 +/- 102.5 fmol/ml; 178.4 +/- 95.2 vs 181.9 +/- 102.5 fmol/ml), in pulmonary artery (58.3 +/- 36.6 vs 51.4 +/- 48.8 fmol/ml; 35.5 +/- 16.9 vs 51.4 +/- 48.8 fmol/ml), in aorta (29.7 +/- 22.7 vs 37.5 +/- 26.3 fmol/ml; 25.2 +/- 9.8 vs 37.5 +/- 26.3 fmol/ml); and in peripheral vein (14.6 +/- 7.9 vs 17.3 +/- 9.7 fmol/ml; 16.2 +/- 12.2 vs 17.3 +/- 9.7 fmol/ml). In conclusion our data show that, providing no hemodynamic changes occur, captopril administration does not alter ANF concentration.

Topics: Adult; Atrial Fibrillation; Atrial Natriuretic Factor; Captopril; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Time Factors; Tricuspid Valve Insufficiency

Plasma atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (GMP) and renin activity (PRA) were measured in 13 patients with mitral stenosis 24 h before and 48 h after balloon valvotomy resulting in a fall in LA pressure from 23.4 +/- 2.2 to 10.5 +/- 0.8 mmHg (P less than 0.01). Before treatment, plasma ANP was higher during ambulation (128.1 +/- 18.5 pg ml-1) than in the supine posture (93.3 +/- 15.0 pg ml-1; P less than 0.01) and did not diminish after return to the erect posture (86.4 +/- 14.1 pg ml-1). A physiological response was restored after valvotomy with ANP plasma levels of 49.2 +/- 7.8 pg ml-1 in the initial ambulant period, 63.1 +/- 12.6 pg ml-1 in the supine posture and 44.6 +/- 8.7 pg ml-1 in the final erect posture. Postural variations of cyclic GMP were parallel to those of ANP. In contrast, LA hypertension did not abolish PRA postural response. During the three successive periods of ambulation, supine posture and erect posture PRA was 5.4 +/- 1.0, 2.8 +/- 0.6 and 5.5 +/- 1.2 ng h-1 ml-1, respectively, before treatment, whereas after treatment the values measured were 10.3 +/- 2.9, 2.3 +/- 0.7 and 7.0 +/- 2.5 ng h-1 ml-1 respectively. Variations of plasma ANP, cyclic GMP and PRA in response to postural changes were also studied in 10 healthy volunteers and in 12 uraemic patients with high plasma ANP.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Atrial Natriuretic Factor; Cardiac Catheterization; Creatinine; Female; Guanosine Monophosphate; Humans; Hypertension; Kidney Failure, Chronic; Male; Middle Aged; Mitral Valve Stenosis; Posture; Reference Values

To investigate the release of atrial natriuretic factor (ANF) in mitral stenosis and the influence of the increase on the frequency of atrial contraction or atrial distention on ANF secretion, we studied 10 patients with symptoms of congestive heart failure (New York Heart Association classes II and III) in sinus rhythm, who were undergoing cardiac catheterization as part of an evaluation workup for mitral stenosis. Echocardiographic tracings, repeat determinations of mean pulmonary artery wedge pressure (MPAWP) and mean right atrial pressure, and blood sampling from the pulmonary artery for measurements of ANF were performed at baseline, during atrial pacing (pacing rate of 125 beats/min for 5 minutes), and 5 minutes after the pacing protocol was completed. Baseline ANF levels were closely related to right atrial pressure (r = 0.89; p less than 0.001) and increased markedly after atrial pacing from 205.6 +/- 39.8 (SEM) to 343.9 +/- 57.9 (SEM) pg/ml. A similar pacing-induced increase was shown for MPAWP and left atrial size. Our data indicate that pacing-induced increases in atrial distention and intracavitary pressure further stimulate release of ANF. However, an independent effect of frequency of atrial pacing on plasma ANF in humans could not be identified.

Topics: Adult; Atrial Natriuretic Factor; Blood Pressure; Cardiac Pacing, Artificial; Female; Heart Atria; Humans; Male; Middle Aged; Mitral Valve Stenosis; Myocardium; Pulmonary Wedge Pressure

The atrial natriuretic factor (ANF) is a hormone whose effects and mode of secretion have been determined. But its exact role in the regulation of volemia in comparison with that of the renin-angiotensin system is still to be defined. Studies of human diseases associated with an increase of ANF plasma concentration may help reach this goal. The mechanisms resulting in elevated ANF plasma concentrations (increase of secretion, decrease of catabolism of the hormone) and the effects of these high levels of ANF on renal functions and circulation are analysed in chronic cardiac failure, mitral stenosis, pulmonary artery hypertension, acute tachycardias, chronic and acute renal failures and in the course of cardiac transplantation. The therapeutic usefulness of drugs inhibiting ANF catabolism (blockers of the clearance receptors for ANF and inhibitors of the enzymes degrading ANF) is also considered.

Topics: Acute Kidney Injury; Atrial Natriuretic Factor; Heart Failure; Heart Transplantation; Humans; Hypertension, Pulmonary; Hypertension, Renovascular; Kidney Failure, Chronic; Mitral Valve Stenosis; Tachycardia, Supraventricular

To study the relation between plasma atrial natriuretic peptide (ANP) and cardiac pressure, and to assess the pathophysiologic significance of ANP in water and electrolyte metabolism, the changes in plasma levels of ANP and arginine vasopressin (AVP) were examined in 11 patients with mitral stenosis who underwent percutaneous transvenous mitral valvuloplasty, and compared with the changes in the renin-angiotensin-aldosterone system and renal function. Immediately after valvuloplasty, plasma ANP levels decreased significantly with a concomitant decrease in mean pressures in the left atrium, the pulmonary artery and the right atrium. Plasma ANP levels decreased to the normal range in 4 of the 6 patients with normal sinus rhythm, while all 5 patients with atrial fibrillation had higher levels despite a similar degree of decrease in atrial pressure. There were significant positive correlations between plasma ANP levels and the mean left atrial pressure (r = 0.61, p less than 0.01), the mean pulmonary arterial pressure (r = 0.49, p less than 0.01) and the mean right atrial pressure (r = 0.54, p less than 0.01). The mean plasma AVP levels, on the other hand, showed a transient increase after valvuloplasty from 0.5 +/- 0.1 to 1.2 +/- 0.4 pg/ml (p less than 0.05). The mean plasma renin activity (1.3 +/- 0.3 vs 2.7 +/- 0.8 ng/ml/hr, p less than 0.05) and plasma aldosterone concentration (8.6 +/- 2.3 vs 17.2 +/- 5.2 ng/dl, p less than 0.05) also increased significantly 30 minutes after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Catheterization; Female; Hemodynamics; Humans; Kidney; Male; Middle Aged; Mitral Valve Stenosis; Renin-Angiotensin System

Knowledge about the stimulus for the release of atrial natriuretic peptide (ANP) from human atria is incomplete. Atrial stretch is known to be a stimulus and atrial tachyarrhythmias are thought to be another. The effects of atrial size (by two-dimensional echocardiography) and atrial fibrillation on the atrial specific granule content of human atria were studied to gain insight into the secretory mechanisms of ANP. An electron microscopic analysis of the atrial granule content was used to study 12 patients--5 with mitral stenosis and sinus rhythm, 3 with mitral stenosis and atrial fibrillation and 4 controls. Granules were counted using a free count and montage method. This is the first report of such a morphometric analysis in humans. Granule counts were significantly raised in the patients with mitral stenosis compared with controls (P less than 0.014). This observation probably reflects a high turnover state induced by elevated atrial pressures. Further support for this conclusion is provided by the demonstration of a positive correlation between granule counts and left atrial size (r = 0.86; P less than 0.01). The tendency for higher counts in patients with atrial fibrillation may be related to the rhythm disturbance itself, but clinical and echocardiographic data suggest more severe atrial pressure overload in this group.

Topics: Adult; Atrial Natriuretic Factor; Cytoplasmic Granules; Heart Atria; Humans; Male; Microscopy, Electron; Middle Aged; Mitral Valve Stenosis

Acute mitral obstruction may lead to an increase in atrial natriuretic peptide (ANP) due to increased atrial pressure and a large increase in arginine vasopressin (AVP) due to simultaneous arterial and ventricular baroreceptor unloading. We measured ANP and AVP concentration after transseptal puncture and during percutaneous retrograde mitral balloon valvuloplasty (PRMV) in 11 patients (mean age 57 +/- 12 years; nine women) with mitral stenosis and congestive heart failure. Atrial septal puncture per se resulted in a significant increase in ANP and AVP without a significant change in aortic pressure. Subsequent PRMV led to a further increase in ANP, a transient decrease in aortic pressure from 89 +/- 7 to 45 +/- 4 mm Hg, and a large (fivefold) increase in AVP. ANP and AVP were no longer different from baseline values 18 to 24 after the procedure. This study suggests that transseptal puncture and acute mitral obstruction are major stimuli to ANP release and that combined unloading of arterial and left ventricular mechanoreceptors is a very potent vasopressinergic stimulus.

Topics: Aged; Aldosterone; Arginine Vasopressin; Atrial Natriuretic Factor; Blood Pressure; Cardiac Output; Catheterization; Female; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Renin; Rheumatic Heart Disease; Time Factors

To clarify the direct contribution of the left atrial pressure to secretion of human atrial natriuretic peptide (hANP), we have attempted to study the relations between plasma hANP levels, neurohumoral factors, and hemodynamic changes in 13 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). After PTMC, the left atrial pressure fell from 14.7 +/- 1.9 (mean +/- SEM) to 6.5 +/- 0.7 mm Hg in all patients studied (p less than 0.0005), whereas there were no remarkable changes in either the right atrial pressure, mean arterial pressure, or heart rate. Plasma immunoreactive hANP levels obtained from the pulmonary artery decreased from 278 +/- 51 to 137 +/- 31 pg/ml after PTMC (p less than 0.0005). There was a significant correlation between the decrement of hANP levels and that of left atrial pressure (r = 0.72, p less than 0.005). Neither plasma renin activity nor norepinephrine levels changed. In contrast, plasma aldosterone concentrations significantly increased from 11.3 +/- 1.5 to 16.4 +/- 2.7 pg/ml after PTMC (p less than 0.01), although there was no casual relation between plasma concentrations of aldosterone and hANP. The present result with PTMC-induced rapid fall of the left atrial pressure with a concomitant reduction in hANP secretion strongly suggests the importance of the left atrial pressure on hANP secretion in humans.

Topics: Adult; Aged; Aldosterone; Atrial Natriuretic Factor; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Stenosis; Norepinephrine; Osmolar Concentration; Renin

To determine whether an acute fall in atrial pressure decreases the secretion of atrial natriuretic peptide in man, changes in the plasma levels of this peptide were studied after catheter balloon valvuloplasty of the mitral valve. Ten patients with severe mitral stenosis were included in the study. The valvuloplasty resulted in an immediate reduction in left atrial pressure and an increase in the mitral valve area. Decreases in right atrial pressure were inconsistent and less significant. Plasma atrial natriuretic peptide levels, which were elevated before the valvuloplasty, decreased significantly in all 10 patients at 15 minutes after the valvuloplasty and reached lower plateaus at 30, 45, and 60 minutes after the procedure. In the seven patients studied for a longer period, both plasma atrial natriuretic peptide levels and the left atrial pressure remained reduced 24 hours after the valvuloplasty. Plasma atrial natriuretic peptide levels before and 30 to 60 minutes after the valvuloplasty were positively correlated to simultaneously determined left and right atrial pressures. These results indicate that atrial stretch caused by increased atrial pressure is an important stimulus for atrial natriuretic peptide release in man. "De-stretching" of the myocytes of the atria results in rapid inhibition of atrial natriuretic peptide secretion.

Topics: Adult; Atrial Natriuretic Factor; Catheterization; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis

Contents and molecular forms of human atrial natriuretic peptide (hANP) in right and left auricle were analyzed by reverse phase high liquid chromatography (RP-HPLC), coupled with radioimmunoassay for hANP. Analyses were done with auricles taken from 4 autopsied cases without heart disease, and 13 patients with heart disease. Both right and left auricular hANP contents in patients with heart disease were higher than those obtained at autopsy. In patients with mitral stenosis (MS) or mitral regurgitation (MR) who have left atrial pressure and/or volume overload, hANP contents in left auricle were higher than those in right auricle. In addition, three types of molecular forms of hANP, (gamma) type, (alpha, beta, gamma) type, (beta, gamma) type, were observed in both right and left atrium. In patients with MS or MR, (beta, gamma) type or (alpha, beta, gamma) type which have beta-hANP immunoreactivity were observed in 8 out of 9 in patients in left auricle, however, in 4 out of 9 patients in right auricle. Our results suggested that the difference of contents and molecular forms of hANP may reflect the pathophysiological role in heart diseases.

Topics: Adult; Aged; Atrial Natriuretic Factor; Child; Female; Heart Atria; Heart Septal Defects, Atrial; Humans; Infant; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Molecular Weight

To investigate the release of atrial natriuretic factor (ANF) in mitral stenosis and the effect of an increased atrial contraction frequency on atrial distension and ANF secretion, we studied 14 patients [New York Heart Association (NYHA) grades II-III] in sinus rhythm, undergoing cardiac catheterization for mitral stenosis. Echocardiographic tracings, repeat determinations of mean pulmonary artery wedge pressure and blood samples from the pulmonary artery for ANF measurements were taken at baseline, during atrial pacing (125 beats/min for 5 min) and 5 min after pacing. After pacing, ANF levels rose markedly with a parallel increase in mean pulmonary artery wedge pressure and left atrial size. These data indicate that atrial pacing is capable of further stimulating ANF release, even in patients with elevated baseline ANF and left atrial pressure and an increased left atrial dimension.

Topics: Adult; Atrial Natriuretic Factor; Cardiac Catheterization; Cardiac Pacing, Artificial; Echocardiography; Female; Heart Atria; Humans; Male; Middle Aged; Mitral Valve Stenosis; Pulmonary Wedge Pressure; Time Factors

To study the relation between plasma atrial natriuretic factor (ANF) and cardiac pressures, we measured plasma ANF in 24 patients with mitral stenosis 30 minutes before and 20 minutes after balloon mitral valvulotomy. All patients were without physical signs of congestive heart failure. Normal sinus rhythm was present in 15 (group 1), whereas the other nine (group 2) had permanent atrial fibrillation. There were no significant differences between groups for basal mean pressures in right atrium (RA), left atrium (LA), and pulmonary artery (PA). Valvulotomy resulted in a fall in both groups (p less than 0.001) in LA and PA mean pressures, whereas heart rate, cardiac index, and RA and aorta (AO) pressures did not change significantly. Basal ANF was not different in either group in RA (240 +/- 43 vs. 266 +/- 35 pg/ml) or AO (441 +/- 92 vs. 643 +/- 70 pg/ml) but tended to be higher in group 2 in LA (428 +/- 88 vs. 682 +/- 84 pg/ml; p = 0.059) and PA (488 +/- 93 vs. 759 +/- 92 pg/ml; p = 0.057). Plasma ANF was the highest in PA, and about 50% ANF was extracted in the systemic circulation. After valvulotomy, plasma ANF was greater (p less than 0.05) in group 2 (372 +/- 90, 755 +/- 152, 805 +/- 134, and 707 +/- 144 pg/ml) than in group 1 (206 +/- 36, 386 +/- 47, 429 +/- 66, and 421 +/- 49 pg/ml), regardless of the site of blood collection (RA, LA, PA, and AO, respectively). PA ANF was correlated with LA pressure (p less than 0.05) in group 1 before as well as after valvulotomy, whereas there was no such correlation in group 2. Cyclic GMP (cGMP) in LA was correlated (p less than 0.01) with PA ANF in group 1, and LA cGMP (10.0 +/- 1.2 and 9.1 +/- 1.8 pmol/ml in groups 1 and 2, respectively) was higher (p less than 0.05) than PA cGMP (9.1 +/- 1.0 and 8.0 +/- 1.5 pmol/ml in groups 1 and 2, respectively) before valvulotomy, which suggests the presence of ANF receptors in the pulmonary circulation. Taken together, these results indicate that in patients in sinus rhythm with mitral stenosis, there is an increase in ANF secretion depending on LA pressure. ANF secretion is also high in patients with mitral stenosis and atrial fibrillation but does not respond appropriately to changes in LA pressure.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Aldosterone; Atrial Fibrillation; Atrial Natriuretic Factor; Catheterization; Coronary Circulation; Cyclic GMP; Female; Hemodynamics; Humans; Male; Mitral Valve Stenosis; Renin; Veins

To assess the effect of short-term alteration of left atrial pressure and volume on the circulating plasma level of atrial natriuretic factor, 11 patients with left atrial hypertension due to mitral stenosis were studied at the time of percutaneous balloon mitral valvuloplasty. Hemodynamic measurements and plasma atrial natriuretic factor levels were obtained before, immediately (5 to 10 min) after and 24 h after valvuloplasty, and echocardiographic left atrial size was determined before and 24 h after valvuloplasty. Immediately after valvuloplasty, left atrial pressure decreased from 28 +/- 2 to 10 +/- 1 mm Hg (p less than 0.0005), mitral pressure gradient decreased from 20 +/- 2 to 7 +/- 1 mm Hg (p less than 0.0005), mitral valve area increased from 0.8 +/- 0.1 to 1.9 +/- 0.2 cm2 (p less than 0.0005) and plasma atrial natriuretic factor level rose from 249 +/- 42 to 348 +/- 50 pg/ml (p less than 0.01). This short-term rise in atrial natriuretic factor level may reflect a transient increase in left atrial pressure associated with balloon occlusion of the mitral valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aldosterone; Atrial Natriuretic Factor; Catheterization; Female; Heart; Heart Atria; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Stenosis; Renin

To clarify the production mechanism of atrial natriuretic peptide (ANP) in right (RA) and left atria (LA) in mitral valve disease, histopathological and immunohistocytochemical analyses were performed and ANP levels were investigated by radioimmunoassay (RIA) in 28 patients. Atrial tissues were obtained during mitral valve replacement. ANP-like immunoreactivity of the myocytes applied by the avidin-biotin peroxidase complex method was observed around the nuclei of the atrial myocytes. Electronmicroscopically, immunoreactivity was observed in atrial specific granules. Light-microscopically determined intensity of the immunoreactivity was classified into 4 grades and the intensity in 100 myocytes was expressed by adding the scores of each myocyte. Mean right atrial pressure was positively correlated with the activity score in RA (r = 0.80). Pulmonary capillary wedge pressure was not correlated with the score in LA. The score in RA was significantly higher than that in LA. The ANP level in RA investigated by RIA was also higher than that in LA. Histopathological findings such as myocyte hypertrophy, degeneration and interstitial fibrosis were more severe in LA than in RA. In conclusion, longstanding atrial overloading, especially in LA, caused severe pathological damage, resulting in a smaller production of ANP. Much more ANP may be produced from RA in long-standing mitral valve disease.

Topics: Adult; Atrial Natriuretic Factor; Blood Pressure; Heart Atria; Humans; Immunohistochemistry; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Pulmonary Wedge Pressure; Radioimmunoassay

Topics: Adult; Atrial Natriuretic Factor; Female; Heart Atria; Humans; Male; Middle Aged; Mitral Valve Stenosis; Myocardium; Pressure

We compared plasma ANP concentration and atrial content of ANP as well as plasma concentrations of other fluid regulating hormones and renal function between the MVR group (n = 12) and the non MVR group (n = 14) during open heart surgery. Preoperatively there was no significant difference in plasma ADH and ACTH between two groups, however plasma ANP was significantly higher in the MVR group (96.9 +/- 16.2 pg/ml) than in the non MVR group (22.8 +/- 8.6 pg/ml) (p less than 0.01). During extracorporeal circulation ANP was at a low level because of aortic clamping. Tissue concentration of ANP in right appendages was higher (p less than 0.02) in the MVR group (61.8 +/- 11.8 nmol/g wet weight) (n = 6) than that in the non MVR group (14.9 +/- 3.1 nmol/g wel weight) (n = 15). Also, concentration in left appendages of the MVR group (50.0 +/- 10.4 nmol/g wet weight) (n = 4) was higher than that in right appendages of the non MVR group (p less than 0.05). From these results it may be concluded that increased secretion of ANP is elicited by left atrial load and probably playing an important role on circulating blood volume regulation.

Topics: Aldosterone; Atrial Natriuretic Factor; Extracorporeal Circulation; Heart Valve Prosthesis; Humans; Kidney; Mitral Valve Insufficiency; Mitral Valve Stenosis; Vasopressins