Atrial natriuretic factor in normal subjects and heart failure patients. Plasma levels and renal, hormonal, and hemodynamic responses to peptide infusion.

Abstract

We investigated atrial natriuretic factor (ANF) in humans, measuring plasma immunoreactive (ir) ANF (in femtomoles per milliliter), and renal, hormonal, and hemodynamic responses to ANF infusion, in normal subjects (NL) and congestive heart failure patients (CHF). Plasma irANF was 11±0.9 fmol/ml in NL and 71±9.9 in CHF (P < 0.01); the latter with twofold night ventricular increment (P < 0.05). In NL, ANF infusion of 0.10 ig/ kg per min (40 pmol/kg per min) induced increases (P < 0.05) of absolute (from 160±23 to 725±198 iseq/min) and fractional(1-4%) sodium excretion, urine flow rate (from 10±1.6 to 20±2.6 ml/min), osmolar (from 3.2±0.6 to 6.8±1.2 ml/min) and free water (from 6.8±1.6 to 13.6±1.6 ml/min) clearances, and filtration fraction (from 20±1 to 26±2%). Plasma renin and aldosterone decreased 33% and 40%, respectively (P < 0.01). Systolic blood pressure fell (from 112±3 to 104±5 mmHg, P < 0.05) in seated NL; but in supine NL, the only hemodynamic response was decreased pulmonary wedge pressure (from 11±1 to 7±1 mmHg, P < 0.05). In CHF, ANF induced changes in aldosterone and pulmonary wedge pressure, cardiac index, and systemic vascular resistance (all P < 0.05); however, responses of renin and renal excretion were attenuated. ANF infusion increased hematocrit and serum protein concentration by 5-7% in NL (P < 0.05) but not in CHF.

Effects of Exogenous and Endogenous Natriuretic Peptides on Forearm Vascular Function in Chronic Heart Failure

“…Many studies have detailed the central hemodynamic, arterial, renal, and adrenal effects of exogenous [1][2][3][4][5][6][7][8] and endogenous 9 NPs in animal models of HF 1 and in human HF, 2-9 but little is known about the effects of NPs on the capacitance vasculature in this condition. In the present study, we assessed the effects of all 4 currently known human NPs on the forearm vasculature in matched groups of optimally treated cHF patients.…”

“…[2][3][4][5][6][7] Hirooka et al 4 and Nakamura et al 6,17 reported reduced forearm resistance-vessel responses to intra-arterial infusion of ANP and BNP (but not CNP) in HF patients versus healthy controls. Interestingly, in these studies, changes in FBF to BNP and CNP were less than those in ANP (on an equimolar basis) in healthy controls, but approximately equipotent in patients with HF.…”

“…[1][2][3][4][5][6][7] Despite minimal effects on plasma volume and resistance vessel tone, infusion of NPs in patients with HF has consistently been shown to reduce central venous pressure (CVP). 8,9 This raises the possibility that the venodilator effects of NPs may be preserved in HF.…”

Hemodynamic and hormonal effects of neutral endopeptidase inhibitor SCH 39370 in sheep.

“…Similar trends have been observed during ANF infusions by others, 21 sometimes with rebound rise after cessation of ANF. 22 Although ANF has been shown to inhibit corticotropin releasing factor release in hypothalamic cells 23 as well as adrenocorticotropin hormone secretion from pituitary cells, 24 further work is required to clarify such an action of ANF in vivo under physiological conditions.…”

Visinin-like protein 1 regulates natriuretic peptide receptor B in the heart

“…Increased cardiac expression of ANP and BNP and release of this peptides into the circulation is a characteristic feature in heart failure. Despite this elevation, the physiologic response to these peptides is diminished [33,34]. Currently two studies were published describing hyporesponsiveness of cardiac and renal tissues to ANP in congestive heart failure.…”