The effect of altering haemodynamics on the plasma concentrations of natriuretic peptides in heart failure
The effect of altering haemodynamics on the plasma concentrations of natriuretic peptides in heart failure
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DOI：
10.1016/j.ejheart.2005.11.018
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发表时间：
2006-10-01
影响因子：
18.2
通讯作者：
Hall, C.
中科院分区：
文献类型：
--
作者：
Larsen, A. I.;Dickstein, K.;Hall, C.
背景资料：利钠肽水平反映心力衰竭患者的血流动力学，并可作为心脏充盈压的生化标志物。本研究的目的是检测心房利钠肽（ANP）、B型利钠肽（BNP）及其N端片段N-ANP和N-BNP对快速和持续血管舒张的反应动力学特征的差异。有症状的充血性心力衰竭（NYHA III）和肺毛细血管楔压（PCWP）> 18 mm Hg，接受硝酸甘油（N=8）或尼可地尔（N=12）24 h输注。在研究期间实现了PCWP的降低。结果：PCWP和右房压下降迅速，然后缓慢上升; ANP和N-ANP表现出相似的模式。相反，BNP和N-BNP水平在整个观察期间稳步下降。这伴随着全身血管阻力（SVR）的持续降低。PCWP与所有利钠肽水平高度相关。使用纵向回归模型评估响应随时间的推移，我们发现单独的，所有的肽和血流动力学variables.Conclusion之间的显着关系：心房利钠肽反映快速变化的充盈压力，而B型肽的反应慢得多。B型肽对充盈压的短期变化不太敏感，但在血管扩张剂治疗期间应能更好地反映SVR的变化。(c)2005年欧洲心脏病学会。Elsevier B. V.出版，保留所有权利。
Background: Natriuretic peptide levels reflect haemodynamics in patients with heart failure and may serve as biochemical markers of cardiac filling pressures. The purpose of this study was to detect differences in the kinetic profile between atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and their N-terminal fragments N-ANP and N-BNP, in response to rapid and persistent vasodilatation.Methods: Sixteen men and four women aged 63.0 +/- 10.4 (mean +/- S.D.) with symptomatic congestive heart failure (NYHA III) and pulmonary capillary wedge pressure (PCWP)> 18 mm Hg, received a 24-h infusion of nitroglycerin (N=8) or nicorandil (N=12). A reduction of PCWP was achieved for the duration of the study. Natriuretic peptides were measured by radioimmunoassay at baseline, 1, 3, 6, 12 and 24 h.Results: PCWP and right atrial pressure fell rapidly and then increased modestly. ANP and N-ANP demonstrated a similar pattern. In contrast, BNP and N-BNP levels fell steadily throughout the observation period. This was accompanied by a continuous reduction of systemic vascular resistance (SVR). PCWP was highly correlated to the levels of all the natriuretic peptides. Using a longitudinal regression model evaluating responses over time, we found separate, significant relationships between all peptides and haemodynamic variables.Conclusion: The atrial natriuretic peptides reflect rapid changes in filling pressures while the B-type peptides respond much slower. B-type peptides are less sensitive to short-term changes in filling pressures, but should reflect changes in SVR better during vasodilator therapy. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.