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Response of atrial natriuretic factor to surgical pericardial drainage in patients with chronic pericardial effusion
P de Groote1, A Millaire, M C Vantyghem
1Department of Cardiology C, Cardiology Hospital, Lille, France.
Insights
Drainage of chronic pericardial effusion significantly increases atrial natriuretic peptide levels, even without tamponade. This hormonal response is linked to reduced right atrial pressure and impacts other key cardiovascular hormones.
Area of Science:
- Cardiology
- Endocrinology
- Physiology
Background:
- Atrial transmural pressure influences atrial natriuretic peptide (ANP) secretion.
- Previous studies focused on patients with pericardial effusion and hemodynamic compromise.
- The ANP response to drainage in chronic effusion without tamponade was uncharacterized.
Purpose of the Study:
- To investigate the effect of chronic pericardial effusion drainage on ANP levels.
- To correlate ANP changes with hemodynamic parameters.
- To examine the impact on plasma renin activity and aldosterone.
Main Methods:
- Studied 13 patients with chronic abundant pericardial effusion but no hemodynamic compromise.
- Measured blood ANP, plasma renin activity, and aldosterone before and after pericardiocentesis.
- Monitored right atrial pressure and mean blood pressure during the procedure.
Main Results:
- Surgical pericardiocentesis significantly increased ANP (12 to 105 pmol/l, P < 0.001).
- ANP increase correlated with a fall in right atrial pressure (r=0.68, P=0.01) and inversely with mean blood pressure rise (r=0.65, P<0.02).
- Plasma renin activity decreased (P < 0.05), while aldosterone initially increased then decreased post-pericardiocentesis (P < 0.02).
Conclusions:
- Surgical pericardiocentesis in chronic pericardial effusion significantly elevates ANP.
- The ANP increase is correlated with decreased right atrial pressure, similar to tamponade cases.
- This suggests ANP secretion is sensitive to atrial pressure changes even without overt hemodynamic compromise.
Abstract:
Previous studies have demonstrated the importance of atrial transmural pressure in the secretion of atrial natriuretic peptide. These studies have been performed in patients with pericardial effusion and hemodynamic compromise. The response of atrial natriuretic peptide to the drainage of chronic pericardial effusion without clinical evidence of tamponade is unknown. We studied 13 patients with chronic abundant pericardial effusion but without hemodynamic compromise. Blood samples for hormonal determinations were drawn before and after surgical pericardiocentesis. Right atrial pressure was measured during the procedure. Drainage induced a significant increase of atrial natriuretic peptide (from 12 +/- 3.9 to 105 +/- 22.8 pmol/l, P < 0.001, mean +/- S.E.M.), correlated with the fall in right atrial pressure (from 7.65 +/- 1.18 to 4.31 +/- 1.46 mmHg, P < 0.05, r = 0.68, P = 0.01). This increase was inversely correlated with the rise of mean blood pressure after surgery (from 84 +/- 2.37 to 100 +/- 5.3 mmHg, P < 0.05, r = 0.65, P < 0.02). Plasma renin activity decreased after drainage (from 8.12 +/- 2.57 to 3.27 +/- 0.65 ng/ml/h, P < 0.05). Surgery induced an increase of plasma levels of aldosterone (from 811 +/- 241 to 1199 +/- 249 pmol/l, P < 0.05), which were reduced after pericardiocentesis (371 +/- 102 pmol/l, P < 0.02). In patients with chronic abundant pericardial effusion, surgical pericardiocentesis induced a significant increase of atrial natriuretic peptide, correlated with a fall in right atrial pressure. The increase of atrial natriuretic peptide was similar than in patients with tamponade, despite a moderate fall in right atrial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)