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Relation of atrial natriuretic peptides to left ventricular systolic and diastolic function in heart failure
A A Wijbenga1, A H Balk, F A Jonkman
1Heart Center, University Hospital Rotterdam, The Netherlands. wybenga@card.azr.nl
Insights
Atrial natriuretic peptides (ANP) and N-terminal pro-ANP levels are elevated in heart failure patients with restrictive left ventricular filling. These peptides offer insights into both systolic and diastolic function in heart failure.
Area of Science:
- Cardiology
- Biochemistry
- Heart Failure Research
Background:
- Plasma atrial natriuretic peptides correlate with atrial pressures.
- Left ventricular ejection fraction and filling abnormalities are linked to atrial pressures.
Purpose of the Study:
- Investigate the relationship between atrial natriuretic peptides and left ventricular systolic and diastolic function in heart failure patients.
- Determine if ANP and NT-proANP levels differ based on left ventricular filling patterns.
Main Methods:
- Measured plasma concentrations of atrial natriuretic peptide (ANP) and N-terminal pro-atrial natriuretic peptide (NT-proANP) in 63 chronic heart failure patients.
- Classified patients into restrictive (n=19) and non-restrictive (n=44) left ventricular filling patterns using Doppler transmitral flow.
Main Results:
- Higher plasma ANP and NT-proANP concentrations were observed in patients with restrictive filling patterns compared to non-restrictive patterns (P<0.0001).
- Both peptides showed correlations with deceleration time, E/A ratio, and left ventricular ejection fraction in univariate analysis.
- Multivariate analysis revealed independent relationships between ANP, NT-proANP, left ventricular ejection fraction, and filling patterns.
Conclusions:
- Atrial natriuretic peptides provide valuable information regarding left ventricular systolic function in heart failure.
- Atrial natriuretic peptides also offer insights into left ventricular diastolic function, particularly filling patterns, in heart failure patients.
Background:
Plasma concentrations of atrial natriuretic peptides are correlated with atrial pressures, as are left ventricular ejection fraction and left ventricular filling abnormalities.
Aims:
This study investigated the relation of atrial natriuretic peptides to both left ventricular systolic and diastolic function in heart failure.
Methods:
Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were measured in 63 patients with chronic heart failure and left ventricular systolic dysfunction. According to Doppler transmitral flow measurements, 19 patients had a restrictive and 44 patients had a non-restrictive left ventricular filling pattern.
Results:
Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were higher in patients with a restrictive filling pattern than in patients with a non-restrictive filling pattern (197 vs. 75 pmol/l, P<0.0001 and 1.14 vs. 0.45 nmol/l, P<0.0001). In univariate analysis, atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide correlated with deceleration time, E/A ratio and left ventricular ejection fraction. In multivariate analysis, both peptides appeared independently related to left ventricular ejection fraction and left ventricular filling pattern.
Conclusion:
In patients with chronic heart failure, atrial natriuretic peptides provide information on left ventricular systolic as well as diastolic function.