Atrial natriuretic factor in cirrhosis with ascites: Plasma levels, cardiac release and splanchnic extraction

Abstract

The aim of this study was to determine the plasma levels, cardiac release and splanchnic extraction of atrial natriuretic factor in cirrhosis with ascites. The plasma concentration of immunoreactive atrial natriuretic factor in samples obtained from an antecubital vein was measured in 18 healthy volunteers and in 35 cirrhotics with ascites. In 11 of these cirrhotics and in 11 patients admitted to the hospital for the study of a thoracic pain who had no clinical or hemodynamic signs of cardiac failure (control group), the plasma levels of immunoreactive atrial natriuretic factor in samples from the coronary sinus, right atrium, pulmonary artery, hepatic vein and femoral vein were determined and the coronary sinus blood flow measured by thermodilution. Cirrhotic patients showed significantly higher plasma levels of immunoreactive atrial natriuretic factor in each vascular territory studied than did control subjects (coronary sinus: 101.2 +/- 10.6 vs. 26.1 +/- 4.7 fmoles per ml; right atrium: 32.5 +/- 5.8 vs. 9.4 +/- 3.5; pulmonary artery: 36.8 +/- 10.1 vs. 7.5 +/- 2.4; hepatic vein: 10.7 +/- 2.0 vs. 2.7 +/- 0.8; femoral vein: 18.2 +/- 2.4 vs. 3.1 +/- 0.9; antecubital vein: 14.7 +/- 1.6 vs. 4.0 +/- 0.8). The coronary sinus blood flow was also higher in cirrhotics (200 + 22 ml per min) than in controls (105 +/- 7 ml per min). Consequently, the estimated cardiac release and cardiac production of immunoreactive atrial natriuretic factor were strikingly increased in cirrhotics (13,334 +/- 2,007 and 5,484 +/- 1,734 fmoles per min, respectively) as compared to control subjects (1,669 +/- 338 and 1,431 +/- 350 fmoles per min, respectively; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The role of atrial natriuretic peptide (ANP) in chronic liver disease

“…In contrast, patients with ascites and peripheral edema exhibited an exaggerated ANP increase following water immersion (Epstein, 1989). Increased ANP plasma concentrations in the coronary sinus and higher coronary sinus blood flow in patients with cirrhosis and ascites as compared to healthy volunteers, unfortunately not matched for age, lead to the estimation of a strikingly increased cardiac release of ANP in cirrhosis (Gines et aL, 1988). Several investigations have demonstrated a marked increase of circulating ANP in patients with cirrhosis and ascites following massive central volume expansion, e.g.…”

Degradation and clearance of atrial natriuretic factors (ANF)

“…[75][76][77][78]). An increased release of ANF h~ been suggested in these diseases (36,(79)(80)(81)(82). However, elevated plasma concentrations might also be caused by decreased clearance.…”

Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems

“…PRA, ALDO, and ET were measured by radioimmunoassay as described in detail elsewhere. 30,31 The plasma concentration of NE was measured by radioimmunoassay (IBL Laboratories, Hamburg, Germany). Normal values of PRA, ALDO, NE, and ET in our laboratory for healthy subjects on a low-sodium diet were: 1.2 Ϯ 0.1 ng/mL · h, 24 Ϯ 2 ng/dL, 233 Ϯ 17 pg/mL, and 5 Ϯ 0.3 pg/mL, respectively.…”