Elsevier

American Heart Journal

Volume 136, Issue 2, August 1998, Pages 297-301
American Heart Journal

Secretion patterns of brain natriuretic peptide and atrial natriuretic peptide in patients with or without pulmonary hypertension complicating atrial septal defect,☆☆,,★★

https://doi.org/10.1053/hj.1998.v136.89729Get rights and content

Abstract

Background This study was designed to investigate plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with atrial septal defect (ASD), whose right ventricular loading patterns vary from simple volume overloading to both volume and pressure overloading.

Methods and Results Plasma ANP and BNP in the pulmonary artery were measured in 31 adult patients with ASD and 11 control subjects. On the basis of the presence of pulmonary hypertension (PH, mean pulmonary arterial pressure >20 mm Hg), patients with ASD were divided into two groups, patients without PH (group 1, n = 21) and those with PH (group 2, n = 10). Cardiac catheterization was performed to measure mean pulmonary arterial pressure and pulmonary blood flow. Plasma ANP was significantly higher in both group 1 and group 2 than in the control group. Plasma BNP and BNP to ANP (BNP/ANP) ratio were significantly higher in group 2 than in the control group, although they were not significantly elevated in group 1. Plasma ANP positively correlated with the degree of pulmonary blood flow (r = 0.54, p < 0.01), whereas plasma BNP positively correlated with the magnitude of mean pulmonary arterial pressure (r = 0.73, p < 0.001). BNP/ANP >1 was a powerful marker for the presence of PH (sensitivity 90%, specificity 90%).

Conclusions Plasma ANP levels were elevated in adult patients with ASD regardless of PH. In contrast, plasma BNP levels were elevated in proportion to the severity of PH complicating ASD. Thus BNP and ANP may represent differing aspects of cardiac response to right ventricular overload in patients with ASD. (Am Heart J 1998;136:297-301.)

Section snippets

Patients

The diagnosis of ASD was made by echocardiography and was confirmed by cardiac catheterization.7 All patients had uncomplicated secundum atrial septal defect. No patient had evidence of Eisenmenger syndrome. Of the 38 consecutive patients with ASD initially examined, 7 patients were excluded because of the presence of atrial fibrillation. The remaining 31 patients (12 men and 19 women, mean age 46 years, range 19 to 72 years) were divided into two groups on the basis of the presence of

Clinical and hemodynamic characteristics

Patients with ASD with pulmonary hypertension (group 2) showed significantly higher values for PAP, RVEDP, and PVR than did those without pulmonary hypertension (group 1) (Table I).

Table l. Clinical and hemodynamic characteristics of control subjects and patients with atrial septal defect

ParameterControl ( n = 11)Group 1 ( n = 21)Group 2 ( n = 10)
Age (yr)50 ± 342 ± 453 ± 5
Sex (M/F)9/28/134/6
NYHA
 I (n)n/a73
 II (n)n/a146
 III (n)n/a01
Sys PAP (mm Hg)24 ± 128 ± 153 ± 4*
Dia PAP (mm Hg)6 ± 17 ± 116 ± 2*

Discussion

In this study, we demonstrated that (1) plasma ANP levels were elevated in patients with ASD regardless of the presence of pulmonary hypertension, and (2) plasma BNP levels and the BNP/ANP ratio were markedly elevated in patients with ASD with pulmonary hypertension, although they were not significantly increased in patients with ASD without pulmonary hypertension. We also demonstrated that (3) plasma ANP levels were positively correlated with the degree of Qp and Qp/Qs; plasma BNP levels

Acknowledgements

We thank Yoko Saito for technical assistance.

References (11)

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From the Department of Internal Medicine and Research Institute, National Cardiovascular Center.

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Supported in part by the Special Coordination Funds for Promoting Science and Technology (Encouragement System of COE) from the Science and Technology Agency of Japan.

Reprint requests: Toshio Nishikimi, MD, Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565 Japan.

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