Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide
Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide
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DOI：
10.1007/s00259-014-2754-2
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发表时间：
2014-09-01
影响因子：
9.1
通讯作者：
Kurabayashi, Masahiko
中科院分区：
文献类型：
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作者：
Kasama, Shu;Toyama, Takuji;Kurabayashi, Masahiko
目的醛固酮阻止心肌摄取去甲肾上腺素。心钠素（ANP）是一种心源性循环激素，可抑制培养心肌细胞醛固酮合成酶基因的表达。我们评估了心钠素静脉注射对心脏交感神经活动（CSNA）和醛固酮抑制急性失代偿性心力衰竭（ADHF.Methods）患者的影响，我们研究了182例中度非缺血性ADHF患者需要住院治疗，并与标准治疗静脉注射心钠素和10名年龄匹配的正常对照组。持续输注ANP> 96 h。在所有受试者中，通过I-123-间碘苄胍（MIBG）放射性造影测定延迟总缺损评分（TDS）、心脏与纵隔比值和洗脱率。通过超声心动图测定左心室（LV）舒张末期容积、收缩末期容积和射血分数。所有急性心力衰竭（AHF）患者均在入院后3天内和4周内检查一次，而对照组仅检查一次（当血流动力学正常时）。结果正常人的I-123-MIBG血流图和超声心动图参数均优于AHF患者（P均< 0.001）。治疗后，AHF患者的所有这些参数均显著改善（均p < 0.001）。62例AHF患者TDS变化百分比与血浆醛固酮浓度呈显著正相关（r=0.539，p < 0.001）。此外，心肌的去甲肾上腺素摄取可以通过抑制含有静脉内ANP的标准治疗后的醛固酮产生来改善。
Purpose Aldosterone prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide (ANP), a circulating hormone of cardiac origin, inhibits aldosterone synthase gene expression in cultured cardiocytes. We evaluated the effects of intravenous ANP on cardiac sympathetic nerve activity (CSNA) and aldosterone suppression in patients with acute decompensated heart failure (ADHF).Methods We studied 182 patients with moderate nonischemic ADHF requiring hospitalization and treated with standard therapy containing intravenous ANP and 10 age-matched normal control subjects. ANP was continuously infused for > 96 h. In all subjects, delayed total defect score (TDS), heart to mediastinum ratio, and washout rate were determined by I-123-metaiodobenzylguanidine (MIBG) scintigraphy. Left ventricular (LV) end-diastolic volume, end-systolic volume, and ejection fraction were determined by echocardiography. All patients with acute heart failure (AHF) were examined once within 3 days and then 4 weeks after admission, while the control subjects were examined only once (when their hemodynamics were normal). Moreover, for 62 AHF patients, plasma aldosterone concentrations were measured at admission and 1 h before stopping ANP infusion.Results I-123-MIBG scintigraphic and echocardiographic parameters in normal subjects were more favorable than those in patients with AHF (all p < 0.001). After treatment, all these parameters improved significantly in AHF patients (all p < 0.001). We also found significant correlation between percent changes of TDS and aldosterone concentrations (r=0.539, p < 0.001) in 62 AHF patients.Conclusion The CSNA and LV performance were all improved in AHF patients. Furthermore, norepinephrine uptake of myocardium may be ameliorated by suppressing aldosterone production after standard treatment containing intravenous ANP.