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Hemodynamic and plasma atrial natriuretic peptide responses to acute digitalis therapy in patients with normal and
Wayne L Miller1, Kent R Bailey, Susan A Weston
1Division of Cardiovascular Diseases, Department of Biostatistics, Mayo Clinic and Mayo Foundation, 200 First Street, SW, Rochester, MN 55905, USA. miller.wayne@mayo.edu
Insights
Digitalis improves heart function in patients with left ventricular dysfunction (LVD) by enhancing hemodynamics. This effect may be linked to digitalis-stimulated release of atrial natriuretic peptide (ANP) during stress.
Area of Science:
- Cardiology
- Pharmacology
- Physiology
Background:
- Digitalis has a historical role in heart failure treatment.
- Its precise effects on cardiac hemodynamics and neurohormonal modulation remain unclear.
Purpose of the Study:
- To investigate the relationship between atrial natriuretic peptide (ANP) and hemodynamic responses to digitalis.
- To assess these effects in patients with normal and impaired left ventricular function (LVD).
Main Methods:
- Thirty patients (20 with LVD, 10 controls) were studied.
- Hemodynamics and plasma ANP were measured supine and with leg elevation, before and after digitalis administration.
Main Results:
- Digitalis improved hemodynamics in LVD patients, reducing heart rate, filling pressures, and mean pulmonary artery pressure while increasing cardiac index.
- These improvements were maintained during leg elevation stress.
- Leg elevation post-digitalis increased ANP levels despite reduced filling pressures.
Conclusions:
- Acute digitalis administration improves cardiac hemodynamics in LVD patients.
- This improvement may involve digitalis-induced release of myocardial ANP under hemodynamic stress.
Background:
Digitalis has a long history in the treatment of heart failure but its effects on cardiac hemodynamics and neurohormonal modulation are not well characterized.
Aims:
The purpose of this study was to evaluate the relationship between atrial natriuretic peptide (ANP) and the hemodynamic responses to acute digitalis administration in patients with normal and impaired left ventricular function (LVD).
Methods And Results:
Thirty patients were enrolled in the study, 20 with LVD (LVEF=22+/-8%) and 10 control subjects (LVEF=77+/-10%). Hemodynamics and plasma ANP concentrations were measured supine and with leg elevation before and after digitalis. In patients with normal ventricular function, the hemodynamic stress of leg elevation in the pre-digitalis state resulted in significant (P<0.05) increases in PAWP and MPAP. Digitalis administration in the supine position produced reductions in heart rate, PAWP, MPAP and CI; SVR was increased. In LVD patients leg elevation further increased PAWP, RAP and MPAP. Digitalis in the supine position, however, reduced RAP, MPAP and PAWP and increased CI. These improved hemodynamics were preserved during the stress of leg elevation. Leg elevation following digitalis resulted in increased ANP concentrations despite decreased cardiac filling pressures.
Conclusions:
Acute digitalis administration results in hemodynamic improvement in LVD patients which may in part result from digitalis stimulated release of myocardial ANP under conditions of hemodynamic stress.