[The acute and 24-hour modifications to the atrial natriuretic factor in patients who have undergone mitral valvuloplasty. The hemodynamic and echocardiographic correlations].

Abstract

BACKGROUND:

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).

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: E Mangieri, C Tosti Croce, G Tanzilli, N Alessandri, R D'Agostino, A Pignatelli, A Lomurno, G M Sardella, M Nardi, G Scibilia
• Journal: Giornale italiano di cardiologia (G Ital Cardiol) Vol. 23 Issue 11 Pg. 1115-23 (Nov 1993) ISSN: 0046-5968 [Print] Italy
• Vernacular Title: Modificazioni acute ed a 24 ore del fattore natriuretico atriale in pazienti sottoposti a valvuloplastica mitralica. Correlazioni emodinamiche ed ecocardiografiche.
• PMID: 8163101 (Publication Type: Journal Article)

Chemical References

• Atrial Natriuretic Factor

Topics

• Adult
• Atrial Natriuretic Factor (blood)
• Cardiac Catheterization
• Catheterization (statistics & numerical data)
• Circadian Rhythm
• Echocardiography (statistics & numerical data)
• Female
• Hemodynamics
• Humans
• Linear Models
• Male
• Middle Aged
• Mitral Valve (diagnostic imaging, physiopathology)
• Mitral Valve Stenosis (blood, diagnostic imaging, physiopathology, therapy)
• Rheumatic Heart Disease (blood, diagnostic imaging, physiopathology, therapy)
• Time Factors