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Hemodynamic response to intracoronary infusion of atrial natriuretic factor in patients with normal or altered left
J L Dubois-Rande1, S Adnot, C Benvenuti
1Departement de Cardiologie et de Physiologie, Hôpital Henri Mondor, Creteil, France.
Insights
Atrial natriuretic factor (ANF) improved cardiac index and reduced systemic vascular resistance in patients with congestive heart failure (CHF) at high doses. This study assessed ANF
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is a complex condition affecting cardiac function.
- Atrial natriuretic factor (ANF) is a hormone with known cardiovascular effects.
Purpose of the Study:
- To evaluate the impact of synthetic human ANF on cardiac function in patients with CHF and healthy controls.
- To determine the dose-response relationship of ANF on hemodynamic parameters.
Main Methods:
- Synthetic human ANF was infused into the left main coronary artery of 8 CHF patients and 6 healthy controls.
- Measurements included plasma ANF concentrations, cardiac index (CI), systemic vascular resistance (SVR), and LV contractility (peak positive dP/dt).
- Infusion rates were incrementally increased to assess dose-dependent effects.
Main Results:
- ANF infusion led to a dose-related increase in plasma ANF levels in both CHF patients and controls.
- At lower infusion rates, no significant changes in CI, SVR, or LV contractility were observed.
- At the highest infusion rate, CI increased and SVR decreased significantly in CHF patients, without affecting heart rate or blood pressure.
Conclusions:
- High-dose ANF administration can improve cardiac index and reduce systemic vascular resistance in patients with CHF.
- ANF demonstrates potential as a therapeutic agent for managing cardiac dysfunction in heart failure.
- Further research is warranted to explore the clinical applications of ANF in cardiovascular medicine.
Abstract:
To assess the effects of atrial natriuretic factor (ANF) on cardiac function, synthetic human ANF was infused directly into the left main coronary artery of eight patients with congestive heart failure (CHF) and six subjects with normal left ventricular (LV) function (controls) who underwent cardiac catheterization. ANF infusion at the incremental rates of 60, 125, 400, and 800 ng/min induced a dose-related increase in plasma ANF concentrations in the coronary sinus, from 1,223 +/- 590 to 3,923 +/- 1,123 pg/ml in patients with CHF (p less than 0.01) and from 1,041 +/- 605 to 2,710 +/- 1,741 pg/ml in controls (p less than 0.01). Peripheral plasma ANF concentrations (femoral artery) increased from 538 +/- 278 to 752 +/- 262 pg/ml (p less than 0.01) in patients with CHF and from 193 +/- 63 to 401 +/- 147 pg/ml (p less than 0.01) in controls. The increase in peripheral or coronary sinus plasma ANF concentrations did not differ between patients with CHF and controls. At the three lowest ANF infusion rates, cardiac index (CI), systemic vascular resistance (SVR), and LV contractility assessed by peak positive dP/dt remained unchanged both in patients with CHF and in controls. At the highest ANF infusion rate, CI increased from 2.18 +/- 0.53 to 2.54 +/- 0.49 L/min/m2 (p less than 0.01) and SVR decreased from 14.6 +/- 3.6 to 12.8 +/- 4.5 mm Hg.min/L (p less than 0.01) in patients with CHF. There was no associated change in heart rate (HR), mean arterial blood pressure (MAP), cardiac filling pressures, or peak positive dP/dt.(ABSTRACT TRUNCATED AT 250 WORDS)