Long-Term Administration of Atrial Natriuretic Peptide in Patients with Acute Heart Failure

Abstract

A short-term treatment of atrial natriuretic peptide (ANP), a circulating hormone of cardiac origin, is reported to improve cardiac performance in patients with chronic heart failure. However, clinical usefulness of long-term administration of ANP in patients with congestive heart failure has not been reported. We studied 36 patients with severe acute heart failure who resisted various therapy. Hemodynamic parameters were measured before and 48 h after initiating ANP infusion (n = 18) or normal saline (n = 18). Mean pulmonary capillary wedge pressure (23-->13 mm Hg), mean right atrial pressure (10-->5 mm Hg), systemic vascular resistance (2,169-->1,307 dyn x s x cm(-5)) and pulmonary vascular resistance (318-->136 dyn x s x cm(-5)) decreased significantly, whereas cardiac index (1.9-->2.6 L/min/m2) and urine volume (1,692-->2,560 ml/day) increased during long-term ANP infusion (before-->48 h). Moreover, in eight patients with long-term ANP infusion, these hemodynamic effects were maintained at 7 days after initiating ANP infusion. Vasodilating, pulmonary vasorelaxant, and diuretic activities of ANP are maintained without tolerance, and thus long-term ANP infusion is clinically useful in patients with severe acute heart failure.

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.…”

“…Systemic infusion of NP 8,27 (or elevation of endogenous NP by inhibiting their breakdown) 9 has been shown to increase stroke volume (SV) 27 and cardiac index 8 in patients with HF, despite a decrease in CVP, 8,9 a finding apparently in conflict with the Frank-Starling mechanism. This is almost certainly caused by a decrease in the volume of the right ventricle and a decrease in pericardial pressure, which increases effective LV distending pressure despite a decrease in LVEDP (ie, diastolic ventricular interaction).…”

“…[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.…”

B-Type Natriuretic Peptide Prevents Acute Hypertrophic Responses in the Diabetic Rat Heart

“…This supports the proposal that exogenous natriuretic peptide administration is an effective strategy to prevent cardiac growth in diabetes, where endothelium-dependent pathways are compromised. Recent reports indicate that exogenous ANP or BNP administration exerts acute hemodynamic benefits in patients with heart failure, despite elevated circulating natriuretic peptide levels (37,38). Whether the benefits of targeting the natriuretic peptide system are also evident in the longer term in vivo, particularly in patients resistant to conventional antihypertensive therapy including ACE inhibitors (39) has yet to be investigated.…”

Marked and Prompt Hemodynamic Improvement by Carperitide in Refractory Congestive Heart Failure due to Dilated Cardiomyopathy.

“…A chest X-ray showed a cardiothoracic ratio of 59% and mild pulmonary congestion. An electrocardiogram demonstrated sinus tachycardia and Q waves in leads I, aV L , and V [5][6] . Hematological examination revealed hemoconcentration and hepatic dysfunction without renal failure.…”