Abstract | OBJECTIVE: 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.
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Authors | Yoshitaka Hayashi, Masakatsu Ohtani, Yoshiki Sawa, Taizo Hiraishi, Yasuhiko Kobayashi, Hikaru Matsuda |
Journal | Journal of cardiovascular pharmacology
(J Cardiovasc Pharmacol)
Vol. 44
Issue 6
Pg. 709-17
(Dec 2004)
ISSN: 0160-2446 [Print] United States |
PMID | 15550792
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Atrial Natriuretic Factor
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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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