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Plasma atrial natriuretic factor in patients with acute myocardial infarction
M Nakamura1, H Yoshida, N Arakawa
1Department of Medicine II, Iwate Medical University, Morioka, Japan.
Insights
Plasma atrial natriuretic factor (ANF) levels are lower in patients with new-onset myocardial infarction (MI) compared to those with prior cardiac or renal conditions. Stimulated ANF release in MI may originate from additional sites beyond the heart, especially in patients with poor prognosis.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Atrial natriuretic factor (ANF) plays a crucial role in cardiovascular homeostasis.
- Understanding ANF secretion patterns in acute myocardial infarction (AMI) is vital for prognosis.
Purpose of the Study:
- To investigate plasma ANF levels in the early phase of AMI.
- To determine if ANF secretion is adequate in new-onset myocardial infarction.
- To explore the relationship between ANF levels, hemodynamic parameters, and patient history.
Main Methods:
- Studied 118 patients with AMI, divided into two groups based on history of cardiac or renal disease.
- Measured plasma ANF concentrations and hemodynamic variables.
- Analyzed ANF levels in relation to pulmonary capillary wedge pressure and patient outcomes.
Main Results:
- Patients without prior cardiac/renal disease (Group A) had significantly lower plasma ANF levels (76 pg/ml) compared to those with such history (Group B, 185 pg/ml).
- ANF correlated with pulmonary capillary wedge pressure in Group B, but not in Group A.
- Higher peripheral ANF levels (>150 pg/ml) were observed in non-survivors.
Conclusions:
- Plasma ANF levels are lower in new-onset AMI patients without prior cardiac/renal disease.
- Stimulated ANF release in AMI may involve extra-cardiac sources, particularly in patients with chronic ventricular overload and poor prognosis.
Abstract:
To examine whether atrial natriuretic factor (ANF) is secreted adequately in the early phase of myocardial infarction, plasma ANF concentration and clinical parameters, including hemodynamic variables, were studied in 118 patients with acute myocardial infarction (AMI). The patients were divided into 2 subgroups according to the absence (group A, n = 41) or presence (group B, n = 77) of a history of valvular heart disease, previous myocardial infarction, hypertension, or renal failure. Although no significant difference in atrial pressure after the infarction was found between the 2 groups, the plasma ANF level was significantly lower in group A than in group B (76 +/- 6 vs. 185 +/- 26 pg/ml; mean +/- SEM, p < 0.01). Plasma ANF was correlated with pulmonary capillary wedge pressure in group B (r = 0.54, p < 0.001), whereas no relationship with hemodynamic parameters was observed in group A. In 56 of the 118 patients (group A, n = 18; group B, n = 38), the pulmonary arterial plasma level was significantly higher in group A (p < 0.05), whereas the difference was not significant in group B. Seven of the 8 expired cases among these 56 patients had peripheral plasma ANF levels of more than 150 pg/ml, which were higher than those in pulmonary arterial plasma. These observations suggest firstly that the plasma level of ANF is lower in patients with a new onset of myocardial infarction compared to those with a history of cardiac or renal diseases, and secondly that stimulated ANF release originates not only from the right side of the heart, but also from additional site(s), particularly in patients with chronic ventricle overload and a poor prognosis.