Inefficacy of daily single bolus dose atrial natriuretic factor in chronic congestive heart failure

We have previously reported a fivefold increase of plasma atrial natriuretic factor (ANF) in patients with congestive heart failure (CHF) compared with normal subjects. However, given the marked increase of ANF under basal conditions, the extent to which ANF secretion can further increase under physiological stress is not been clarified in CHF. We therefore evaluated ANF secretion during ergometric exercise in 11 patients with CHF, with peripheral venous ANF samples obtained at rest and peak exercise. In seven patients, simultaneous peripheral venous and right ventricular ANF samples were obtained to estimate myocardial ANF secretion. Hemodynamic characteristics of exercise included a significant increase of heart rate, mean arterial pressure, and cardiac output (all P < 0.01); reduction of systemic vascular resistance (P < 0.001); and increase of right atrial and pulmonary wedge pressures (P < 0.001). ANF was abnormally elevated at baseline (108 +/- 58 fmol/ml) yet increased further to 183 +/- 86 fmol/ml with exercise (P < 0.003). A step-up of right ventricular ANF, particularly during exercise, was consistent with active myocardial secretion, despite elevated baseline ANF levels.

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Responsiveness of atrial natriuretic factor to reduction in right atrial pressure in patients with chronic congestive heart failure

Journal of the American College of Cardiology ◽

10.1016/0735-1097(88)90281-1 ◽

1988 ◽

Vol 11 (6) ◽

pp. 1191-1198 ◽

Cited By ~ 27

Author(s):

Mark A. Creager ◽

Alan T. Hirsch ◽

Elizabeth G. Nabel ◽

Sally S. Cutler ◽

Wilson S. Colucci ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Atrial Natriuretic Factor ◽

Atrial Pressure ◽

Right Atrial ◽

Right Atrial Pressure ◽

Chronic Congestive Heart Failure ◽

Natriuretic Factor ◽

Atrial Natriuretic

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Clearance receptor-mediated control of atrial natriuretic factor in experimental congestive heart failure

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1994.266.3.r936 ◽

1994 ◽

Vol 266 (3) ◽

pp. R936-R943

Author(s):

R. R. Brandt ◽

M. M. Redfield ◽

L. L. Aarhus ◽

J. A. Lewicki ◽

J. C. Burnett

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Atrial Natriuretic Factor ◽

Urinary Sodium Excretion ◽

Control Group ◽

Chronic Congestive Heart Failure ◽

Group Of Seven ◽

Natriuretic Factor ◽

Clearance Receptor ◽

Atrial Natriuretic

Circulating atrial natriuretic factor (ANF) is regulated by clearance receptors (ANFR-C). C-ANF-(4-23) is a ring-deleted analogue of ANF, which binds specifically to ANFR-C. The present studies were undertaken to determine total metabolic (TMCR), pulmonary (PCR), and renal clearance rates (RCR) of ANF in a group of seven mongrel dogs in chronic congestive heart failure (CHF) in comparison with a control group (n = 6). TMCR was not altered in CHF [1,534 +/- 319 vs. control: 1,735 +/- 208 ml/min; P = not significant (NS)] in association with an elevation of circulating endogenous ANF (206 +/- 44 vs. control: 36 +/- 10 pg/ml; P < 0.01). Infusion of C-ANF-(4-23) reduced TMCR in both groups similarly (CHF: 753 +/- 134 vs. control: 972 +/- 156 ml/min; P = NS). PCR was lower in CHF (286 +/- 431 vs. 1,672 +/- 407 ml/min; P < 0.05), whereas RCR was not different (10 +/- 24 vs. control: 15 +/- 25 ml/min; P = NS). ANFR-C blockade did not facilitate urinary sodium excretion in CHF. These studies demonstrate that 1) TMCR does not contribute to elevated endogenous ANF in CHF; 2) total functional activity of the clearance receptor pathway is preserved in CHF; and 3) renal ANF metabolism and the clearance receptor pathway are not linked to the avid sodium retention and renal ANF resistance observed in chronic CHF.

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