Myocardial Protective Effect of Human Atrial Natriuretic Peptide in Cardiac Surgery - "hANP Shot" in Clinical Safety Trial -

Abstract

Background:We studied low-dose human atrial natriuretic peptide (hANP) infusion therapy during cardiac surgery and reported the cardiac and renal protective effects. The efficacy of a bolus injection of hANP (the "hANP shot") simultaneously with induction of cardioplegia has been proven in animal experiments. In the present study the clinical effects of this "hANP shot" were examined. Methods and Results:The subjects were 67 patients undergoing Coronary artery bypass grafting. At the time of inducing cardioplegia, 1 group received a simultaneous bolus injection of 100 μg of hANP (hANP group) and the other group received an injection of physiological saline (placebo group). The primary endpoints were (1) operative mortality and complications, and (2) the creatine kinase isoenzyme MB (CPK-MB), troponin-I, and human heart fatty acid binding protein (H-FABP) levels. The secondary endpoints were (1) the incidence of arrhythmia, and levels of (2) atrial and B-type natriuretic peptides, and cyclic guanosine monophosphate (cGMP), and (3) renin, angiotensin II, and aldosterone. Postoperative CPK-MB, troponin-I, and H-FABP levels were significantly lower in the hANP group than in the placebo group. Postoperative arrhythmia was significantly less frequent in the hANP group than in the placebo group. Conclusions:It is possible to achieve cardioprotective effects based on the safety of the "hANP shot", as well as from biomarkers of ischemia and results related to arrhythmia. The "hANP shot" should also be evaluated as a safer and new cardioprotective method for cardiac surgery. (Circ J 2011; 75: 2144 - 2150

Cyclic GMP-Dependent Signaling in Cardiac Myocytes

“…NP (nesiritide) failed to show benefit in acute decompensated heart failure, but its cardioprotective effect, particularly against ischemic injury, warrants further investigation. 78 …”

Degradation of the endothelial glycocalyx in clinical settings: searching for the sheddases

“…Unfortunately, to date no such drug is approved for use in man . On the other hand, the potential of natriuretic peptides to initiate destruction of the glycocalyx may well explain the unequivocal or poor long term results obtained in clinical studies aiming to improve heart function or to limit the consequences of myocardial infarction by applying recombinant human BNP (nesiritide) or ANP (carperitide) .…”

Is Human Atrial Natriuretic Peptide (hANP) Effective as an Additive to Cardioplegic Solution During Cardiac Surgery?

“…11 In previous clinical studies, a significant increase in plasma cGMP levels was reported during continuous lowdose hANP infusion (0.02-0.05 μg · kg -1 · min -1 ), which was associated with improved hemodynamic parameters such as pulmonary capillary wedge pressure, right atrial pressure, cardiac index, left ventricular stroke work index, and systemic…”