Effects of intravenous atrial natriuretic peptide on cardiac sympathetic nerve activity and left ventricular remodeling in patients with first anterior acute myocardial infarction
Effects of intravenous atrial natriuretic peptide on cardiac sympathetic nerve activity and left ventricular remodeling in patients with first anterior acute myocardial infarction
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DOI：
10.1016/j.jacc.2006.09.048
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发表时间：
2007-02-13
影响因子：
24
通讯作者：
Kurabayashi, Masahiko
中科院分区：
文献类型：
--
作者：
Kasama, Shu;Toyama, Takuji;Kurabayashi, Masahiko
目的探讨心房利钠肽（ANP）对首次前路急性心肌梗死（AMI）患者冠状动脉成形术后心脏交感神经活动（CSNA）和左室重构的影响。肾素-血管紧张素-醛固酮系统（RAAS）的激活可阻止心肌对去甲肾上腺素的摄取。心房利钠肽是一种源自心脏的循环激素，具有血管扩张和利尿的特性，并能抑制RAAS。方法对50例首次前路AMI患者进行研究，随机分为A组和13组，分别在冠脉成形术前后接受ANP治疗和硝酸异山梨酯治疗。ANP或ISDN连续输注> 48 h，采用tc -99m焦磷酸盐显像法测定范围评分（ES），评价初次血管成形术后3 ~ 5天的初始心肌损伤面积。2周后通过左心室造影测定左室舒张末期容积（LVEDV）和左室射血分数（LVEF）。3周后采用i -123-间碘苄基胍显像法测定延迟性心脏/纵隔计数（H/M）比、延迟性总缺陷评分（TDS）和洗脱率（WR）。结果原发性血管成形术后，两组患者的年龄、性别、危险因素、血肌酸磷酸激酶峰值浓度、再通时间、ES相似。而A组（n = 25） TDS显著低于B组（n = 25）（34.8比41 +/- 8，p < 0.05）， H/M比显著高于B组（1.96 +/- 0.18比1.74 +/- 0.23,p < 0.05）， WR显著低于B组（n = 25）（35 +/- 8%比44 +/- 12%，p < 0.005）。A组LVEDV、LVEF优于B组（LVEDV: 85.5 +/- 28.5 ml vs. 106.3 +/- 39.4 ml [p < 0.05]; LVEF: 47.9 +/- 10.2% vs. 41.5 +/- 11.8% [p < 0.05]）。结论静脉注射ANP可改善首次前路AMI患者的CSNA，防止左室重构。
Objectives We sought to evaluate the effects of atrial natriuretic peptide (ANP) on cardiac sympathetic nerve activity (CSNA) and left ventricular (LV) remodeling in patients with first anterior acute myocardial infarction (AMI) after primary coronary angioplasty.Background The activation of the renin-angiotensin-aldosterone system (RAAS) prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide, a circulating hormone of cardiac origin, has vasodilatory and diuretic properties, and can inhibit the RAAS.Methods We studied 50 patients with first anterior AMI who were randomly assigned to receive ANP (group A) or isosorbide dinitrate (group 13) before and after primary coronary angioplasty. The ANP or ISDN was continuously infused > 48 h. The extent score (ES) was determined from Tc-99m-pyrophosphate scintigraphy to evaluate the area of initial myocardial damage 3 to 5 days after primary angioplasty. The LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF) were determined by left ventriculography 2 weeks later. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from I-123-meta-iodobenzylguanidine scintigraphy after 3 weeks.Results After primary angioplasty, age, gender, risk factors, peak serum creatine phosphokinase concentration, recanalization time, and ES were similar in the 2 groups. However, in group A (n = 25), the TDS was significantly lower (34 8 vs. 41 +/- 8; p < 0.05), the H/M ratio was significantly higher (1.96 +/- 0.18 vs. 1.74 +/- 0.23; p < 0.05), and the WR was significantly lower (35 +/- 8% vs. 44 +/- 12%; p < 0.005) than in group B (n = 25). Moreover, the LVEDV and LVEF in group A were better than in group B (LVEDV: 85.5 +/- 28.5 ml vs. 106.3 +/- 39.4 ml [p < 0.05]; LVEF: 47.9 +/- 10.2% vs. 41.5 +/- 11.8% [p < 0.05]).Conclusions Intravenous ANP improves CSNA and prevents LV remodeling in patients with first anterior AMI.