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Atrial natriuretic factor, cardiac volumes and filling pressures during exercise in congestive heart failure
J E Donckier1, P M De Coster, J L Vanoverschelde
1Division of Internal Medicine, University of Louvain, University Hospital UCL of Mont-Godinne, Yvoir, Belgium.
Insights
Congestive heart failure (CHF) patients have higher resting atrial natriuretic factor (ANF) levels, linked to increased cardiac volumes. Exercise increases ANF in both CHF patients and healthy individuals, regulated by filling pressures in CHF.
Area of Science:
- Cardiology
- Endocrinology
- Physiology
Background:
- Atrial natriuretic factor (ANF) plays a crucial role in cardiovascular homeostasis.
- Understanding ANF regulation mechanisms in congestive heart failure (CHF) is vital for managing the condition.
Purpose of the Study:
- To investigate the regulation of ANF release at rest and during exercise in patients with CHF.
- To compare ANF release patterns between CHF patients and healthy individuals.
Main Methods:
- Measured plasma ANF concentrations, cardiac volumes, and filling pressures in six male CHF patients and 13 healthy males.
- Evaluated these parameters at rest and during three graded exercise levels (E1, E2, E3).
Main Results:
- CHF patients exhibited sixfold higher resting ANF concentrations and threefold increased end-systolic ventricular volumes compared to controls.
- A strong positive correlation was observed between end-systolic ventricular volumes and plasma ANF at rest (r = 0.93).
- During exercise, ANF increased similarly in both groups, but cardiac volumes and filling pressures rose abnormally in CHF patients, correlating with ANF levels.
Conclusions:
- ANF release in CHF at rest is primarily regulated by cardiac volumes, even with normal filling pressures.
- ANF release during exercise is not impaired in CHF patients with normal resting filling pressures.
- Left ventricular filling pressures regulate ANF release during exercise in CHF.
Abstract:
To study the mechanism of atrial natriuretic factor (ANF) release in heart failure, we measured plasma ANF concentrations, cardiac volumes and filling pressures at rest and during three graded exercise levels (E1, E2, E3) in six male patients with congestive heart failure (CHF) and compared them with 13 normal male subjects. At rest, ANF concentrations were sixfold higher in patients with CHF than in normal subjects (at rest: 53 +/- 12 vs 8 +/- 1 pmol.l-1; P less than 0.02). End-systolic ventricular volumes were increased threefold in patients with CHF (P less than 0.02) despite normal mean central venous pressure, pulmonary artery pressure (PAP) and pulmonary wedge pressure (PWP). A positive correlation was found between end-systolic ventricular volumes and plasma ANF (r = 0.93, P less than 0.001). During exercise, ANF rose by 120% over basal values both in patients with CHF and in normal subjects (P less than 0.01). Volumes higher than normal in patients with CHF increased further at E2 (P less than 0.05) in contrast to a decrease of systolic volumes recorded in normal subjects (P less than 0.05). Filling pressures rising abnormally in patients with CHF correlated with plasma ANF during exercise (r = 0.53, P less than 0.02 for PAP; r = 0.51, P less than 0.05 for PWP). In conclusion, our data suggest that ANF release in CHF is regulated at rest by cardiac volumes when filling pressures are still normal. During exercise, ANF release is not impaired in CHF with normal rest filling pressures and is regulated during exercise by left filling pressures.