atrial-natriuretic-factor and Pericardial-Effusion

This article will review the results of recent clinical studies relating to the pericardial fluid in patients with various heart diseases. In ischemic patients, several angiogenic growth factors are accumulated in a high concentration in pericardial fluid. These may contribute to the angiogenesis and arteriogenesis, which are self-protecting mechanisms of myocardial ischemia. In congestive heart failure, natriuretic peptides are released into the pericardial fluid in a higher concentration compared with plasma levels. This suggests that these peptides may act as autocrine and/or paracrine factors. Pericardial fluid from ischemic patients induces cell proliferation and apoptosis depending on the cell type. Intrapericardial drug administration may provide a reasonable therapeutic strategy for heart diseases. In conclusion, the analysis of pericardial fluid appears to be a logical approach for elucidation of the pathophysiology of the heart.

Topics: Angiogenesis Inducing Agents; Apoptosis; Atrial Natriuretic Factor; Heart; Heart Diseases; Humans; Natriuretic Peptide, Brain; Pericardial Effusion

The present study investigated the molecular pathology of atrial and brain natriuretic peptides (ANP and BNP) in the myocardium to evaluate terminal cardiac function in routine forensic casework with particular regard to fatal drug intoxication (n = 18; sedative-hypnotics, n = 10; methamphetamine, n = 8), hypothermia (cold exposure, n = 13), and hyperthermia (heatstroke, n = 10), compared with that in acute ischemic heart disease (AIHD, n = 35) and congestive heart disease (CHD, n = 11) as controls (total n = 87; within 48 h postmortem). Quantitative analyses of myocardial ANP and BNP messenger RNA demonstrated that their expressions in bilateral atrial and ventricular walls were high in methamphetamine intoxication and hypothermia, comparable to those in AIHD and CHD, but were low in sedative-hypnotic intoxication and hyperthermia. In pericardial fluid, both ANP and BNP levels were increased in hypothermia, while CHD cases had an elevated BNP level, and ANP level showed a tendency to increase in hyperthermia; however, immunohistochemistry showed no evident differences in myocardial ANP and BNP among the causes of death. These findings suggest terminal high cardiac strain in methamphetamine intoxication, decreased cardiac strain in sedative-hypnotic intoxication and hyperthermia (heatstroke), and persistent congestion in hypothermia (cold exposure).

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Autopsy; Cause of Death; Female; Gene Expression; Heart Atria; Heart Failure; Heart Ventricles; Heat Stroke; Humans; Hypnotics and Sedatives; Hypothermia; Illicit Drugs; Male; Methamphetamine; Middle Aged; Myocardial Ischemia; Myocardium; Natriuretic Peptide, Brain; Pathology, Molecular; Pericardial Effusion; Poisoning; Postmortem Changes; Prescription Drug Misuse; RNA-Directed DNA Polymerase; RNA, Messenger

It is well known that the plasma concentrations of atrial and brain natriuretic peptides, as cardiac hormones, are elevated in heart failure.. Pericardial fluid in patients with various heart diseases contains both natriuretic peptides that are released into the pericardial fluid. However, it is unknown whether these peptides reflect cardiac function in patients with various heart diseases, more than both the peptides in blood.. Plasma and pericardial fluid samples were obtained from 22 patients undergoing cardiac surgery for the measurement of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in plasma and pericardial fluid.. The ANP levels in pericardial fluid were higher in patients with impaired left ventricular systolic function (ejection fraction<50% versus>or=50%; 77.0+/-4.9 versus 14.0+/-50.9, p=0.017), but not BNP.However, BNP levels in pericardial fluid were significantly higher in patients with left ventricle dilatation (left ventricular diastolic dimension54 mm; 130.3+/-68.9: 709.7+/-324.7, p=0.0168). Moreover, BNP levels in pericardial fluid were significantly higher in Grade III than Grade II and I (Grade I: echo-free space<5 mm, Grade II: 5-10 mm, Grade III: >10 mm).. These results suggest that BNP levels in pericardial fluid served as more sensitive and accurate indicators of left ventricular diastolic dysfunction, and that increased BNP levels in pericardial fluid may have an important pathophysiologic role in heart failure as a cardiocyte-derived antifibrotic factor.

Topics: Atrial Natriuretic Factor; Biomarkers; Cardiac Surgical Procedures; Heart Failure; Humans; Least-Squares Analysis; Natriuretic Peptide, Brain; Pericardial Effusion

There is epidemiologic evidence that the prognosis of patients with nonischemic heart failure is better than that for patients with ischemic heart failure. In addition, studies have revealed that patients with ischemic heart failure show a poorer response to medical therapy. However, the pathophysiologic difference between ischemic and nonischemic heart disease is unclear. To clarify this point, we measured atrial natriuretic peptide, brain natriuretic peptide, angiotensin II, endothelin (ET)-1. interleukin-1beta interleukin-6. tumor necrosis factor (TNF)-alpha soluble TNF receptor I, and soluble TNF receptor II concentrations in plasma and pericardial fluid in patients with ischemic or nonischemic heart disease undergoing cardiac surgery. The pericardial ET-1 concentration in patients with ischemic heart disease was statistically greater than that in patients with nonischemic heart disease (about 1.5-fold), although no difference was found in the plasma ET-1 concentration. These findings suggest that the production and secretion of ET-1 from the myocardium in patients with ischemic heart disease are augmented to a greater extent than in patients with nonischemic heart disease. This result may lead to a greater understanding of the pathophysiology of ischemic heart disease.

Topics: Angiotensin II; Atrial Natriuretic Factor; Endothelin-1; Growth Substances; Humans; Myocardial Ischemia; Myocardium; Natriuretic Peptide, Brain; Pericardial Effusion; Prognosis; Receptors, Tumor Necrosis Factor

Pericardial fluid (PF) contains several vasoactive agents in higher concentrations than venous plasma (VP). However, with human atrial natriuretic peptide (ANP) controversial data have been reported in earlier studies performed on a limited number of patients (less than 20). The present study was designed to characterize the ANP levels in human PF and cardiac tissues, and to ascertain whether myocardial ischemic state is a major factor in determining ANP production of the human heart. In a total of 316 consecutive patients undergoing open heart surgery ANP levels in VP, PF, atrial and ventricular tissues were measured by radioimmunoassay and analyzed by high-performance liquid chromatography (HPLC). The data are presented as median and 25th-75th percentiles. Our results showed ANP concentration [ANP] of PF significantly exceeded that of VP and [ANP] in the atrial tissue was significantly higher than in the ventricular tissue (p < 0.001). In patients without myocardial ischemia (valvular heart disease) [ANP] in the PF was 258.3 (189.9-342.5) pg/ml, in the VP 28.4 (11.7-57.6) pg/ml and 151.7 (78.4-447.6) ng/mg in the atrial, 0.4 (0.2-1.6) ng/mg in the ventricular tissue. The corresponding values for patients with coronary artery disease were 208.1 (153.8-318.9) pg/ml in the PF, 19.8 (9.4-27.9) pg/ml in the VP, 129.6 (66.5-455.0) ng/mg in the atrial and 1.0 (0.1-1.8) ng/mg in the ventricular tissue. The ventricular tissue levels correlated to the atrial tissue levels (r = 0.317; p < 0.05). Great difference (p < 0.001) was found in the atrial tissue levels between females [414.6 (119.7-734.4) ng/mg] and males [105.4 (65.3-204.2) ng/mg]. In HPLC analysis the majority of the pericardial fluid and tissue ir-ANP coeluted with human ANP [99-126]. In conclusion, [ANP] in PF of cardiosurgical patients is higher by an order of magnitude than in VP. Intrapericardial ANP may reflect the peptide concentration in the myocardial interstitium and may represent a paracrine regulatory mechanism, which seems independent of ANP-induced putative antiischemic influences.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Chromatography, High Pressure Liquid; Female; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Ischemia; Pericardial Effusion; Radioimmunoassay

Experimental studies have demonstrated that adrenomedullin (AM) has a positive inotropic action and exerts inhibitory effects against ventricular remodelling as an autocrine and paracrine factor. However, there is no clinical evidence for AM acting as a local regulator in the human heart. We measured the levels of various molecular forms of AM, i.e. an active form of mature AM (AM-m), an intermediate inactive form of glycine-extended AM (AM-Gly) and total AM (AM-T=AM-m+AM-Gly), in plasma and pericardial fluid using our newly developed immunoradiometric assay in consecutive 67 patients undergoing coronary artery bypass graft surgery. Pericardial fluid and plasma cAMP, atrial natriuretic peptide and brain natriuretic peptide levels were also measured. The relationships between pericardial fluid AM levels and ventricular functions and other hormone levels were analysed. The level of each molecular form of AM in pericardial fluid was closely correlated with that of the other molecular forms of AM in the fluid. However, levels were not correlated with those in plasma. AM-T levels were slightly higher in pericardial fluid than in plasma (+72%; P<0.05), whereas AM-m levels and AM-m/AM-T ratios were markedly higher in pericardial fluid than in plasma (AM-m, +994%; AM-m/AM-T ratio, +443%; both P<0.01). AM-m, AM-Gly and AM-T levels in pericardial fluid were correlated with indices of left ventricular function, and with atrial natriuretic peptide and brain natriuretic peptide levels. Interestingly, AM and cAMP levels were positively correlated in plasma, but negatively correlated in pericardial fluid. In addition, AM-m, AM-Gly and AM-T levels in pericardial fluid were higher in patients with acute coronary syndrome than in those with stable ischaemic heart disease (AM-m, +80%; AM-Gly, +96%; AM-T, +83%; all P<0.01). These results suggest that AM in pericardial fluid reflects cardiac synthesis, and that enhanced cardiac secretion of AM is associated with left ventricular dysfunction, ventricular overload and myocardial ischaemia. Considering that AM has positive inotropic, coronary vasodilatory and anti-remodelling actions, increased cardiac AM may play a compensatory role in the ischaemic and failing myocardium.

Topics: Adrenomedullin; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Coronary Artery Bypass; Coronary Disease; Cyclic AMP; Female; Humans; Immunoradiometric Assay; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Peptides; Pericardial Effusion; Ventricular Function, Left

In the present study we examined plasma and pericardial fluid ANP and BNP concentrations in postinfarction ventricular dysfunction. The association of peptide levels to left ventricular (LV) dysfunction and to the localization of the myocardial infarction (MI) was studied.. Plasma and pericardial fluid samples were obtained from 37 patients undergoing coronary bypass surgery. According to the ECG and preceding coronary angiography, the patients were divided into three groups: previous anterior myocardial infarction (MI) (n=12), previous inferior/posterior MI (n=15) and no history of MI (n=10). When compared to the control group with no MI, the patients with anterior MI had elevated plasma ANP and BNP (134+/-13 vs. 81+/-15 pg/ml, P<0.01 and 95+/-10 pg/ml vs. 26+/-8 pg/ml, P<0.01, respectively) and pericardial fluid BNP (473+/-60 pg/ml vs. 57+/-8 pg/ml, P<0.001) levels. The plasma natriuretic peptide concentrations were not increased in the patients with inferior/posterior MI, but the pericardial fluid BNP concentrations were greater than in the patients with no history of MI (129+/-35 pg/ml vs. 57+/-8 pg/ml, P<0.05). Six of the 12 patients with previous anterior MI had LVEF> or =45%. Despite their normal LV systolic function, these patients had increased plasma and pericardial fluid BNP levels when compared to the group with no history of MI (68+/-18 pg/ml vs. 26+/-8 pg/ml, P<0.05 and 534+/-258 pg/ml vs. 57+/-8 pg/ml, P<0.01, respectively).. Previous anterior myocardial infarction was associated with increased cardiac BNP production even if the LV systolic function was normal (LVEF> or =45%). The high pericardial fluid BNP concentrations in postinfarction patients suggest that the BNP synthesis and release are augmented in the ventricular myocardium independent from the LVEF.

Topics: Adult; Aged; Analysis of Variance; Atrial Natriuretic Factor; Case-Control Studies; Coronary Artery Bypass; Female; Humans; Linear Models; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Paracrine Communication; Pericardial Effusion; Ventricular Dysfunction, Left

The purpose of this study was to investigate whether atrial and brain natriuretic peptides (ANP and BNP, respectively) represent autocrine/paracrine factors and are accumulated in pericardial fluid.. ANP and BNP, systemic hormones produced by the heart, have elevated circulating levels in patients with heart failure. Recent evidence suggests that the heart itself is one of the target organs for these peptides.. With an immunoreactive radiometric assay, we measured the concentrations of these peptides in plasma and pericardial fluid simultaneously in 28 patients during coronary artery bypass graft surgery.. The pericardial levels of BNP were markedly elevated in patients with impaired left ventricular function. We investigated the correlation of ANP and BNP levels in plasma or pericardial fluid with left ventricular hemodynamic variables. None of the hemodynamic variables correlated with ANP levels in plasma or pericardial fluid. Both plasma and pericardial fluid levels of BNP were significantly related to left ventricular end-diastolic and systolic volume indexes (LVEDVI and LVESVI, respectively). In addition, BNP pericardial fluid levels had closer relations with LVEDVI (r = 0.679, p < 0.0001) and LVESVI (r = 0.686, p < 0.0001) than did BNP plasma levels (LVEDVI: r = 0.567, p = 0.0017; LVESVI: r = 0.607, p = 0.0010). BNP levels in pericardial fluid but not in plasma correlated with left ventricular end-diastolic pressure (r = 0.495, p = 0.0074).. BNP levels in pericardial fluid served as more sensitive and accurate indicators of left ventricular dysfunction than did BNP levels in plasma. Thus, BNP may be secreted from the heart into the pericardial space in response to left ventricular dysfunction, and it may have a pathophysiologic role in heart failure as an autocrine/paracrine factor.

Topics: Aged; Atrial Natriuretic Factor; Autocrine Communication; Biomarkers; Cardiac Output, Low; Cardiac Volume; Coronary Artery Bypass; Coronary Disease; Diastole; Female; Hemodynamics; Humans; Hypertension; Male; Mitral Valve Insufficiency; Myocardial Ischemia; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Paracrine Communication; Pericardial Effusion; Radioimmunoassay; Systole; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Pressure

Previous studies have demonstrated the importance of atrial transmural pressure in the secretion of atrial natriuretic peptide. These studies have been performed in patients with pericardial effusion and hemodynamic compromise. The response of atrial natriuretic peptide to the drainage of chronic pericardial effusion without clinical evidence of tamponade is unknown. We studied 13 patients with chronic abundant pericardial effusion but without hemodynamic compromise. Blood samples for hormonal determinations were drawn before and after surgical pericardiocentesis. Right atrial pressure was measured during the procedure. Drainage induced a significant increase of atrial natriuretic peptide (from 12 +/- 3.9 to 105 +/- 22.8 pmol/l, P < 0.001, mean +/- S.E.M.), correlated with the fall in right atrial pressure (from 7.65 +/- 1.18 to 4.31 +/- 1.46 mmHg, P < 0.05, r = 0.68, P = 0.01). This increase was inversely correlated with the rise of mean blood pressure after surgery (from 84 +/- 2.37 to 100 +/- 5.3 mmHg, P < 0.05, r = 0.65, P < 0.02). Plasma renin activity decreased after drainage (from 8.12 +/- 2.57 to 3.27 +/- 0.65 ng/ml/h, P < 0.05). Surgery induced an increase of plasma levels of aldosterone (from 811 +/- 241 to 1199 +/- 249 pmol/l, P < 0.05), which were reduced after pericardiocentesis (371 +/- 102 pmol/l, P < 0.02). In patients with chronic abundant pericardial effusion, surgical pericardiocentesis induced a significant increase of atrial natriuretic peptide, correlated with a fall in right atrial pressure. The increase of atrial natriuretic peptide was similar than in patients with tamponade, despite a moderate fall in right atrial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Atrial Function, Right; Atrial Natriuretic Factor; Catecholamines; Drainage; Humans; Middle Aged; Pericardial Effusion; Punctures; Renin-Angiotensin System; Vasopressins

Topics: Atrial Function; Atrial Natriuretic Factor; Cardiac Catheterization; Cardiac Tamponade; Drainage; Female; Hemodynamics; Humans; Male; Pericardial Effusion

Factors regulating the secretion of atrial natriuretic hormone (ANH) and arginine vasopressin (AVP) have not been elucidated fully. In several studies the release of these peptides has been studied by inducing both increased atrial pressure and atrial distension. A few studies employ cardiac tamponade, allowing the effect of atrial pressure and atrial stretch to be studied separately. In eleven dogs with spontaneous cardiac tamponade the effect of pericardiocentesis on circulating concentrations of ANP and AVP was studied. Pericardiocentesis was followed by a prompt rise in (non-elevated) plasma ANH concentrations from 21.6 +/- 7.3 to 65.4 +/- 17.1 pmol/l (mean +/- SEM). The initially slightly elevated AVP concentration of 5.5 +/- 1.5 pmol/l declined following pericardiocentesis to 2.1 +/- 0.5 pmol/l. In three dogs the systolic arterial pressure was measured indirectly and the central venous pressure was measured with a fluid-filled catheter. Before and after pericardiocentesis arterial pressure readings did not change significantly. Central venous pressure values showed an immediate very steep significant decrease after centesis. It is concluded that ANH release is primarily regulated by stretch and not by atrial pressure, that plasma AVP concentrations are moderately elevated in cardiac tamponade and that in cardiac tamponade pericardiocentesis causes a rapid decline in plasma AVP concentration.

Topics: Animals; Arginine Vasopressin; Atrial Natriuretic Factor; Cardiac Catheterization; Cardiac Tamponade; Central Venous Pressure; Dog Diseases; Dogs; Drainage; Female; Male; Pericardial Effusion; Pericardium; Punctures

Topics: Atrial Natriuretic Factor; Humans; Pericardial Effusion

The epicardial release of immunoreactive atrial natriuretic peptides (ir-ANPs) in inside-out perfused rabbit atria has been reported. In order to determine the presence of ir-ANPs in pericardial fluid and to evaluate their biochemical characteristics, we measured the concentration of ir-ANPs in pericardial fluid obtained from the patients with congenital heart diseases during open heart surgery. Serial dilution curves made with the extrats of pericardial fluid using Sep-Pak C18 cartridges were parallel with standard curve. The concentration of ir-ANPs in pericardial fluid was significantly lower than the corresponding plasma concentration. On gel permeation and reverse-phase high performance liquid chromatography, the ir-ANPs in pericardial fluid, plasma and atrial appendage showed both high and low molecular weights. The major peak of ir-ANPs in plasma was observed at the corresponding fraction to the alpha-human ANP and considerable amount of high molecular weight form of ir-ANPs was observed in pericardial fluid. However, the major peak of ir-ANPs in atrial appendage was observed at the corresponding fraction to the rat pro-ANP. The data suggest that ir-ANPs exist both high and low molecular weight forms in pericardial fluid.

Topics: Atrial Natriuretic Factor; Chromatography, High Pressure Liquid; Female; Heart Defects, Congenital; Humans; Male; Pericardial Effusion; Radioimmunoassay

We studied the response of atrial natriuretic peptide to the hemodynamic and renin-aldosterone variations occurring in four patients who developed cardiac tamponade, either occurring in idiopathic fashion in one or secondary to metastatic involvement of the pericardium in three. Right atrial pressure, heart rate and arterial blood pressure were monitored and serial blood samples were taken before and over three hours after pericardiocentesis. During cardiac tamponade, normal levels of atrial natriuretic peptide (mean +/- SEM: 54 +/- 7.4 pg/ml) were observed in the plasma despite increased right atrial pressure (23 +/- 3.8 cm H2O) and heart rates (98 +/- 4.4). Removal of pericardial fluid (540 to 1160 ml) was associated at first with a 200% increase in plasma concentrations of atrial natriuretic peptide (108 +/- 8.8 pg/ml; P less than 0.001), then with a gradual decline toward normal levels, simultaneous with the normalization of right atrial pressure and heart rate. Activity of renin and concentrations of aldosterone in the plasma were increased during tamponade and returned gradually to normal after pericardiocentesis (3.8 +/- 0.9 to 1.2 +/- 0.3 ng/ml/h and 20 +/- 4.2 to 9 +/- 3.2 ng/dl, respectively; P less than 0.01). These data confirm that atrial strain, not intracavitary pressure in itself nor heart rate, is the main determinant of the acute release of atrial natriuretic peptide, which is associated with a suppressing effect on the renin-aldosterone system. In addition, our data indicate that secretion of atrial natriuretic peptide during cardiac tamponade is not stimulated by secondary hyperaldosteronism.

Topics: Adult; Aldosterone; Atrial Function; Atrial Natriuretic Factor; Blood Pressure; Cardiac Tamponade; Female; Heart; Heart Rate; Humans; Male; Middle Aged; Pericardial Effusion; Renin; Suction

A 41-year-old woman was admitted to our hospital because of scleroderma and combined valvular disease (mitral stenosis, aortic regurgitation, tricuspid regurgitation) associated with massive pericardial effusion. Plasma atrial natriuretic peptide (alpha-hANP) level was 130 pg/ml on admission, and increased temporarily with a decrease of pericardial effusion, without significant of changes of pulmonary capillary wedge pressure, pulmonary arterial pressure, right ventricular pressure nor right atrial pressure. These findings suggest that one of the mechanisms of alpha-hANP secretion, a stretch receptor mechanism, is interfered by the massive pericardial effusion. There was no relationship between atrial pressures and plasma alpha-hANP levels in this case. alpha-hANP concentration in pericardial effusion (486 pg/ml) was four to five folds higher than the plasma alpha-hANP levels.

Topics: Adult; Atrial Natriuretic Factor; Echocardiography; Electroencephalography; Female; Humans; Pericardial Effusion; Scleroderma, Systemic

Topics: Adult; Aged; Atrial Natriuretic Factor; Blood Pressure; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pericardial Effusion; Pericardium; Punctures; Suction; Time Factors

To assess the response of atrial natriuretic peptide (ANP) to rapidly changing right atrial pressures in vivo, we measured ANP levels in 15 patients undergoing the Fontan procedure and compared them with control levels in nine patients undergoing cardiac surgery for lesions not associated with atrial hypertension. There were no significant differences in preoperative ANP levels: 57 +/- 15 pg/ml for patients undergoing the Fontan procedure, 43 +/- 8 pg/ml for control patients. There was no significant change in ANP during surgery or in the postoperative period in control patients. In contrast, ANP increased significantly to 333 +/- 70 pg/ml (p less than .0025) after establishment of right atrial-pulmonary artery continuity with the Fontan procedure and was related to right atrial pressure, which increased from 5 mm Hg before to 14 mm Hg after the Fontan procedure (p less than .001). There was no significant change in left atrial pressure. During the first postoperative day, ANP levels fell to 141 +/- 34 pg/ml (p less than .01) but later increased to 290 +/- 80 pg/ml (p less than .025), a finding that may suggest depletion of a readily releasable intracellular pool of ANP before mobilization of a storage pool. There was no direct relationship between ANP levels and effusions in patients undergoing the Fontan procedure. Pharmacologically significant increases in ANP occur in patients undergoing the Fontan procedure, correlating with increased right atrial pressures, but the relationship between ANP and the fluid derangements after the procedure remains unclear.

Topics: Atrial Natriuretic Factor; Blood Vessel Prosthesis; Child; Heart Atria; Heart Defects, Congenital; Humans; Pericardial Effusion; Pleural Effusion; Postoperative Period; Pulmonary Artery; Water-Electrolyte Balance

Fluid and electrolyte homeostasis is impaired in patients suffering from hypothyroidism and myxedema because myxedema induces retention of salt and water. We have measured plasma levels of human atrial natriuretic peptide (hANP) in 8 female patients who had been totally thyroidectomized because of thyroid carcinoma. Estimations of the hormone were done 4 weeks after diagnostic withdrawal (searching for iodine retaining metastases) and after 2 weeks and 4 weeks of reinitiation of thyroid suppressive therapy by L-thyroxine. hANP levels, although within the normal range (10-80 ng/l) throughout the study, were positively linked to the amount of pericardial effusion (determined by echocardiography), which was highest initially and decreased or vanished with duration of L-thyroxine therapy. Additionally, a positive correlation between thyroid hormone levels and hANP was obtained when the counteracting effect of pericardial effusion was allowed for by partial correlation analysis. Our findings might facilitate explanation of mild polyuria in hyperthyroidism and impaired water excretion in hypothyroidism.

Topics: Adult; Atrial Natriuretic Factor; Female; Humans; Middle Aged; Pericardial Effusion; Thyroid Diseases; Thyroid Hormones; Water-Electrolyte Imbalance