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Circulation, Vol 84, 1581-1588, Copyright © 1991 by American Heart Association
M Yoshimura, H Yasue, E Morita, N Sakaino, M Jougasaki, M Kurose, M Mukoyama, Y Saito, K Nakao and H Imura
BACKGROUND. This study was designed to examine the hemodynamic, renal, and
hormonal effects of brain natriuretic peptide (BNP) infusion in patients
with congestive heart failure (CHF) and in control subjects. METHODS AND
RESULTS. We infused synthetic human BNP at a rate of 0.1 micrograms/kg/min.
BNP infusion decreased pulmonary capillary wedge pressure (control, from 5
+/- 1 to 2 +/- 1 mm Hg, p less than 0.01; CHF, from 21 +/- 3 to 14 +/- 4 mm
Hg, p less than 0.05) and systemic vascular resistance (control, from 1,264
+/- 75 to 934 +/- 52 dyne.sec.cm-5; CHF, from 2,485 +/- 379 to 1,771 +/-
195 dyne.sec.cm-5; p less than 0.01, respectively) and increased stroke
volume index (control, from 49.9 +/- 2.7 to 51.5 +/- 2.3 ml/m2, p = NS;
CHF, from 25.6 +/- 3.8 to 32.0 +/- 3.9 ml/m2, p less than 0.01). BNP
infusion significantly increased urine volume (control, from 2.3 +/- 0.7 to
7.5 +/- 1.9 ml/min; CHF, from 0.8 +/- 0.2 to 5.3 +/- 1.0 ml/min; p less
than 0.01, respectively), excretion of sodium (control, from 79.2 +/- 21.6
to 332.8 +/- 70.9 microEq/min; CHF, from 77.4 +/- 20.8 to 753.5 +/- 108.0
microEq/min; p less than 0.01, respectively), and excretion of chloride
(control, from 72.5 +/- 18.4 to 256.0 +/- 43.3 microEq/min; CHF, from 74.0
+/- 19.6 to 708.8 +/- 103.3 microEq/min; p less than 0.01, respectively).
Urinary excretion of sodium and of chloride in response to BNP infusion was
higher in patients with CHF than in control subjects (p less than 0.01,
respectively). BNP infusion increased the levels of plasma atrial
natriuretic peptide (control, from 65 +/- 11 to 84 +/- 14 pg/ml; CHF, from
262 +/- 65 to 301 +/- 62 pg/ml; p less than 0.05, respectively) and
decreased plasma aldosterone concentrations in both groups (control, from
43.3 +/- 12.1 to 27.3 +/- 7.1 pg/ml; CHF, from 91.1 +/- 34.3 to 66.3 +/-
27.2 pg/ml; p less than 0.05, respectively). CONCLUSIONS. We conclude that
BNP infusion improves left ventricular function in patients with CHF by
vasodilation and prominent natriuretic action.
ARTICLES
Hemodynamic, renal, and hormonal responses to brain natriuretic peptide infusion in patients with congestive heart failure
Division of Cardiology, Kumamoto University Medical School, Japan.
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