R. Wiedemann et al., Atrial natriuretic peptide in severe primary and nonprimary pulmonary hypertension - Response to iloprost inhalation, J AM COL C, 38(4), 2001, pp. 1130-1136
Citations number
29
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES The goal of this study was to assess atrial natriuretic peptide
(ANP) levels during inhalation of iloprost in severe primary (PPH) and nonp
rimary pulmonary hypertension (NPPH).
BACKGROUND The ANP system is activated in pulmonary hypertension and may he
lp protect from right ventricular (RV) decompensation. It-is unknown if ANP
regulation is the same in severe PPH and NPPH and if the dynamic regulatio
n is intact in a highly activated ANP system.
METHODS In 11 patients with PPH and seven patients with NPPH, right heart c
atheter investigations were performed. Pulmonary and systemic artery ANP an
d cyclic guanosine monophosphate(cGMP) levels as well as hemodynamics were
measured before and after iloprost inhalation.
RESULTS The baseline hemodynamics of patients with PPH and patients with NP
PH were comparable (mean pulmonary artery pressure [mPAP]: 61 +/- 5 mm Hg v
s. 52 +/- 5 min Hg, pulmonary vascular resistance [PVR]: 1,504 +/- 153 dyne
(.)s(.)cm(-5) vs. 1,219 +/- 270 dyne(.)s(.)cm(-5). Atrial natriuretic pepti
de and cGMP levels were increased about tenfold and fivefold compared with
controls in both PPH and NPPH. Iloprost inhalation significantly decreased
mPAP (-9.1 +/- 2.5 mm Hg vs. -7.9 +/- 1.5 mm Hg), PVR (-453 +/- 103 dyne(.)
s(.)cm(-5) vs. -381 +/- 114 dyne(.)s(.)cm(-5)), ANP (-99 +/- 63 pg/ml vs. -
108 +/- 47 pg/ml) and cGMP (-4.6 +/- 0.9 nMvs. -4.2 +/- 1.6 nM). Baseline A
NP including all patients significantly correlated with PVR, right atrial p
ressure, cardiac index, RV ejection fraction, mixed venous oxygen saturatio
n and cGMP.
CONCLUSIONS The ANP system is highly activated in patients with severe PPH
and NPPH. Atrial natriuretic peptide levels are significantly correlated wi
th parameters of RV function and pre- and afterload. Iloprost inhalation ca
uses a rapid decrease in ANP and cGMP in parallel with pulmonary vasodilati
on and hemodynamic improvement. (C) 2001 by the American College of Cardiol
ogy.