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Normalization of circulating atrial natriuretic peptides in cardiac transplant recipients
M W Weston1, G B Cintron, A T Giordano
1Department of Medicine, University of South Florida Health Sciences Center, Tampa.
Insights
Heart transplantation (Htx) normalizes elevated atrial natriuretic peptides in heart failure patients. Peptide levels in recipients returned to healthy adult ranges within 5-12 days post-transplant.
Area of Science:
- Cardiology
- Endocrinology
- Transplantation Medicine
Background:
- Congestive heart failure (CHF) is characterized by elevated circulating atrial natriuretic peptides.
- These peptides play a role in fluid and electrolyte balance.
Purpose of the Study:
- To investigate the impact of heart transplantation (Htx) on elevated atrial natriuretic peptide levels in CHF patients.
- To determine the time course of normalization of these peptides after Htx.
Main Methods:
- Measurement of N-terminus, midportion, and C-terminus of pro-atrial natriuretic factor in 14 CHF patients undergoing Htx.
- Serial blood sampling before Htx and up to 6 months post-Htx.
- Correlation analysis with hemodynamic parameters like right atrial pressure.
Main Results:
- Immediately after Htx, elevated peptide levels were observed in most subjects.
- Atrial natriuretic peptide levels correlated with right atrial pressure in the first 24 hours.
- In 11 out of 14 recipients, peptide concentrations normalized to healthy adult levels within 5-12 days post-Htx.
Conclusions:
- Successful heart transplantation effectively restores elevated circulating atrial natriuretic peptide concentrations.
- This normalization suggests improved cardiac function and fluid balance post-Htx.
Abstract:
To assess whether heart transplantation (Htx) alters the marked elevation of circulating atrial natriuretic peptides usually found in patients with congestive heart failure (CHF), 14 subjects (nine with compensated and five with decompensated CHF), each with an ejection fraction < or = 28%, were evaluated. Immediately before and hourly for the first 12 hours after Htx, then daily for 21 days and every 1 to 4 weeks for 6 months, the circulating concentrations of the N-terminus (pro atrial natriuretic factor [ANF] 1-98), midportion of the N-terminus (pro ANF 31-67), and C-terminus (that is, ANF) of the 126 amino acid prohormone were measured. Increased (p < 0.001) levels of these peptides were found in superior vena cava, right atrial, and peripheral venous samples 1 hour after Htx in all subjects except one. The atrial natriuretic peptide levels correlated only with right atrial pressure (p < 0.01) in the first 24 hours. Circulating concentrations of these peptides returned to those of healthy adults between 5 and 12 days after Htx in 11 out of 14 Htx recipients. Thus successful Htx can restore the elevated circulating concentrations of atrial natriuretic peptides to those of healthy adults.