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Left atrial diameter is a simple indicator of a deficiency in atrial natriuretic peptide secretion in patients with mitral stenosis: efficacy of postoperative supplementation with synthetic human alpha-atrial natriuretic peptide.

AbstractOBJECTIVE:
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.
METHODS:
(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).
RESULTS:
(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.
CONCLUSIONS:
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.
AuthorsYoshitaka Hayashi, Masakatsu Ohtani, Yoshiki Sawa, Taizo Hiraishi, Yasuhiko Kobayashi, Hikaru Matsuda
JournalJournal of cardiovascular pharmacology (J Cardiovasc Pharmacol) Vol. 44 Issue 6 Pg. 709-17 (Dec 2004) ISSN: 0160-2446 [Print] United States
PMID15550792 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Atrial Natriuretic Factor
Topics
  • Aged
  • Atrial Natriuretic Factor (deficiency, therapeutic use)
  • Female
  • Heart (anatomy & histology)
  • Heart Atria (anatomy & histology, diagnostic imaging, physiopathology)
  • Heart Valve Prosthesis Implantation
  • Hemodynamics (drug effects)
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency (surgery)
  • Mitral Valve Stenosis (metabolism, physiopathology, surgery)
  • Postoperative Care
  • Ultrasonography

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