Atrial natriuretic factor in patients with right ventricular infarction

Abstract

To determine the possible role of atrial natriuretic factor in right ventricular infarction, serial measurements of this hormone were performed in 21 patients with acute inferior myocardial infarction. All patients underwent enzymatic, electrocardiographic, echocardiographic and coronary arteriographic studies. Ten patients also had right heart hemodynamic measurements. Eight patients had evidence of an associated right ventricular infarction (Group I) and 13 patients did not (Group II). Enzymatically estimated infarct size, presence of left heart failure and arrhythmias were similar in both groups. Mean arterial pressure in Group I (72.1 +/- 4.4 mm Hg) was significantly lower (p = 0.02) than in Group II (89.5 +/- 4.6 mm Hg). Seven (88%) of the eight patients in Group I had elevated right atrial pressures and a higher incidence than Group II of prolonged hypotension (75%) and right ventricular dysfunction (75%) clinically and by echocardiography. Plasma atrial natriuretic factor levels (mean values +/- SEM in pg/ml) for days 1, 2, 3 and 7 after infarction were, respectively: 152 +/- 30, 165 +/- 48, 199 +/- 27 and 189 +/- 31 for Group I versus 55 +/- 9, 55 +/- 11, 61 +/- 13 and 77 +/- 20 for Group II. The difference between groups was significant for days 1 (p less than 0.05), 3 and 7 (p less than 0.01) and not significant for day 2 (p = 0.07). These findings show that atrial natriuretic factor elevation is part of the neurohumoral response to right ventricular infarction and are consistent with the hypothesis that atrial natriuretic factor may play a pathophysiologic role in the right ventricular infarct syndrome.

Tricuspid annular motion in right coronary artery-related acute inferior myocardial infarction with or without right ventricular involvement

“…These patients are at increased risk of death, shock, and arrhythmias (8,9). Currently ST segment elevation in the right precordial leads, particularly RV4, is the most powerful predictor of RV involvement in the setting of inferior wall MI (3,10). The sensitivity of this finding is lower than specificity and even when strictly employed, however, the criteria lead to underestimation of the true incidence of right ventricular infarction.…”

Das atriale natriuretische Peptid als Indikator einer milden postoperativen kardialen Dysfunktion nach unkomplizierter Bypasschirurgie

“…Verschiedenste Untersuchungen zeigten ebenfalls, dass links-und rechtsventrikuläre Infarzierungen ein potenter Stimulus für erhöhte ANP-Ausschüt-tungen sind (5,18,22,26,29). Die erhöhten ANP-Konzentrationen bei Ischämie scheinen mit der ventrikulären Dysfunktion sowie mit dem atrialen Druck und der atrialen Dehnung als stärkstem Reiz für die ANP-Ausschüttung positiv korreliert zu sein (10,14,22).…”

“…Mehrere international veröffentlichte Studien beschäftigen sich mit der Rolle des ANPs im Zusammenhang mit ischämischen Ereignissen am Myokard und der Frage, ob die Konzentrationsverläufe dieses Hormons zur Einschätzung der kardialen Funktion herangezogen werden können (1,5,7,19,21,22,27,28). Auch die Rolle des TnTs in der Bypasschirurgie zur Abschätzung des myokardialen Schadens und als Verlaufsmarker für die Beeinträchtigung der Funktion des linken Ventrikels und des oxidativen Metabolismus wurden mehrfach untersucht (12,13,25).…”

Neuroendocrine activation after myocardial infarction

“…'7 21 Furthermore, disproportionately high plasma concentrations of atrial natriuretic peptide have been observed in patients with myocardial infarction extending to the right ventricle, suggesting that the peptide may have a pathophysiological role in the clinical right ventricular infarction syndrome. 22 Of the three natriuretic peptides, the rise in C-ANP concentration seems to be most abrupt after myocardial infarction. Plasma concentration of C-ANP has usually reached its peak value at the time of admission, and, in uncomplicated infarctions, it usually returns to near normal values within hours or a few days.…”