Hemodynamic and renal effects of atrial natriuretic peptide in congestive heart failure

Michael A. Fifer, Cesar R. Molina, Antonio C. Quiroz, Thomas D. Giles, Howard C. Herrmann, Ivan R. De Scheerder, Denis L. Clement, Spencer Kubo, Robert J. Cody, Jay N. Cohn, Michael B. Fowler

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62 Scopus citations

Abstract

The hemodynamic and renal effects of anaritide (human atrial natriuretic peptide 102-126), a synthetic analog of atrial natriuretic peptide, were evaluated in 35 patients with chronic New York Heart Association class II to IV heart failure. There were 32 men and 3 women, aged 33 to 75 (mean ± standard error of the mean 56 ± 2) years. In the first phase of the study, right-sided heart catheterization was performed, and anaritide was administered as 1-hour infusions. The rate of the infusion varied among patients from 0.03 to 0.3 μg/kg/min. In response to anaritide, there were decreases in mean systemic arterial (94 ± 2 to 87 ± 2 mm Hg), right atrial (10 ± 1 to 8 ± 1 mm Hg), mean pulmonary arterial (33 ± 2 to 28 ± 2 mm Hg) and pulmonary artery wedge (22 ± 2 to 15 ± 2 mm Hg) pressures (all p < 0.05). Cardiac index increased (2.39 ± 0.15 to 2.62 ± 0.15 liters/min/m2, p < 0.05) and heart rate was unchanged. Systemic vascular resistance decreased significantly, but pulmonary vascula resistance was unchanged. There were increases in urine volume (1.6 ± 0.2 to 2.3 ± 0.4 ml/ min), sodium excretion (47 ± 13 to 74 ± 20 μEq/ min) and fractional excretion of sodium (0.41 ± 0.11 to 0.59 ± 0.14%, all p < 0.05), while potassium excretion and creatinine clearance did not change. In the second phase of the study, patients received 2-hour infusions of anaritide (0.03 to 0.6 μg/kg/min) and placebo with noninvasive monitoring. Mean systemic arterial pressure and plasma norepinephrine concentration decreased, while urine volume, sodium excretion and fractional excretion of sodium increased (all p < 0.05) during anaritide infusion, but were unchanged on placebo. Adverse effects, usually related to excessive reduction of systemic arterial pressure, were observed in 6 patients. Short-term infusion of atrial natriuretic peptide produces improvement in hemodynamics and renal function in patients with heart failure.

Original languageEnglish (US)
Pages (from-to)211-216
Number of pages6
JournalThe American Journal of Cardiology
Volume65
Issue number3
DOIs
StatePublished - Jan 15 1990

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