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Prolonged hemodynamic benefits from a high-dose bolus injection of human atrial natriuretic factor in congestive
T D Giles1, A C Quiroz, L E Roffidal
1Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112.
Insights
Atrial natriuretic factor (ANF) safely improved hemodynamic parameters in patients with congestive heart failure. High-dose ANF bolus administration demonstrated therapeutic potential for heart failure management.
Area of Science:
- Cardiology
- Pharmacology
- Physiology
Background:
- The role of atrial natriuretic factor (ANF) in congestive heart failure (CHF) is not fully understood.
- Previous research has yielded confusing results regarding ANF's physiologic and pharmacologic effects in CHF.
Purpose of the Study:
- To evaluate the hemodynamic responses to intravenous bolus doses of human ANF (102-126) in patients with CHF.
- To determine the safety and therapeutic potential of ANF in managing chronic heart failure.
Main Methods:
- Twelve patients with congestive heart failure received intravenous bolus doses of ANF (102-126) at 2.0 or 4.5 micrograms/kg.
- Hemodynamic parameters were monitored using pulmonary and systemic arterial catheters.
- Responses were assessed at 30 and 120 minutes post-administration.
Main Results:
- The 4.5 micrograms/kg dose of ANF significantly decreased heart rate, right atrial pressure, and pulmonary capillary wedge pressure.
- These beneficial hemodynamic effects persisted for at least 120 minutes.
- No clinically significant side effects were observed, indicating a favorable safety profile.
Conclusions:
- Intravenous bolus administration of high-dose ANF is safe and simple in patients with chronic heart failure.
- ANF demonstrates pharmacologic activity and holds therapeutic potential for improving hemodynamic function in heart failure.
Abstract:
The physiologic and potential pharmacologic roles of atrial natriuretic factor in congestive heart failure have remained confusing. We have evaluated the hemodynamic responses to human atrial natriuretic factor [ANF (102-126)] given as bolus intravenous doses of 2.0 or 4.5 micrograms/kg to 12 patients with congestive heart failure. Responses were monitored with pulmonary and systemic arterial catheters in place. By 30 minutes after 4.5 micrograms/kg ANF (n = 6), heart rate decreased from 97 +/- 16 to 91 +/- 15 beats/min, right atrial pressure from 14 +/- 4 to 12 +/- 3 mm Hg, and pulmonary capillary wedge pressure from 33 +/- 3 to 23 +/- 2 mm Hg (all p less than 0.05); responses persisted for 120 minutes. Mean arterial pressure, cardiac index, stroke volume index, and pulmonic and systemic vascular resistances did not change significantly. The 2.0 micrograms/kg ANF dose produced similar responses, but only heart rate and right atrial pressure decreased significantly. No clinically important side effects were noted. High-dose ANF bolus doses can be administered simply and safely and improve hemodynamic parameters in chronic heart failure. Therefore ANF does have pharmacologic activity in heart failure and may have therapeutic potential.