Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis,☆☆,

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Abstract

Brain natriuretic peptide (BNP) is a novel cardiac hormone secreted predominantly from the ventricle. We examined the plasma levels of BNP and atrial natriuretic peptide (ANP) in 13 patients with aortic stenosis undergoing corrective surgery. Preoperative plasma BNP and ANP levels correlated highly with preoperative left ventricular end-systolic wall stress (ESS) ( r = 0.96, p < 0.0001 and r = 0.95, p < 0.0001, respectively). Moreover, between preoperative and late postoperative states, the difference of the plasma levels of BNP and ANP correlated with the difference of ESS. In two patients with elevated ESS and quite high preoperative plasma BNP (>1000 pg/ml), rapid decrease of the plasma level after operation was observed. These results suggest that synthesis and secretion of BNP and ANP are stimulated by the increase of left ventricular end-systolic wall stress in patients with aortic stenosis. (Am Heart J 1997;133:307-14.)

Section snippets

Patients

Thirteen patients (5 men and 8 women; range 52 to 78 years, mean 66 years) with AS were the subjects of this study (Table I) . The diagnosis of AS was made by cardiac catheterization and echocardiography. Three patients were also diagnosed as having mild aortic regurgitation. Tricuspid regurgitation was observed in one patient. Mitral regurgitation was not found in any patients. Preoperative renal function was within normal limits (BUN ≤23 mg/dl, serum creatinine ≤2.0 mg/dl) in 11 patients. In

Plasma levels of BNP and ANP in patients before operation and in unaffected subjects

Table I shows the plasma levels of BNP and ANP in the patients with AS or CAD before operation and in the unaffected subjects. The Log BNP in the unaffected subjects, in the patients with CAD, and in the patients with AS was 1.12 ± 0.09, 1.55 ± 0.11, and 2.24 ± 0.16, respectively (Fig. 1) .

. Plasma BNP and ANP levels in unaffected subjects (normal) , preoperative patients with CAD, and preoperative patients with AS.

These values were significantly different among the three groups ( p < 0.0001),

DISCUSSION

This study demonstrated that the plasma levels of BNP and ANP were elevated in the patients with AS compared with the unaffected subjects. As we previously reported, BNP is synthesized predominantly in the cardiac ventricle, 3, 23 and the increase of the plasma level of BNP is caused by the increase of ventricular production of BNP. 3 This study therefore suggested that, in the patients with AS, the synthesis of BNP can be stimulated either by elevated left ventricular systolic pressure itself

Acknowledgements

We thank Dr. Jun-ichi Soneda, Dr. Toshifumi Takeuchi, Dr. Teiji Oda, Dr. Kazunobu Nishimura, and the staff of the Department of Cardiovascular Surgery, Kyoto University Hospital, for their cooperation in this study. We also thank Mr. Shigeru Kubo in Kyoto Koseikai Hospital and Ms. Yuko Mori for technical assistance.

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    From the Departments of Cardiovascular Surgery, Anesthesia, and Medicine and Clinical Science, Kyoto University Graduate School of Medicine.

    ☆☆

    Reprint requests: Katsuhiko Matsuda, MD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-01 Japan.

    0002-8703/97/$5.00 + 0 4/1/75865

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