Myocardial Circulatory and Metabolic Effects of Atrial Natriuretic Peptide After Coronary Artery Bypass Grafting

The purpose of this study was to examine the effects of incremental infusion rates of human atrial natriuretic peptide (ANP), 25, 50, 100 ng [centered dot] kg sup -1 [centered dot] min-1, on myocardial blood flow and metabolism (n = 10), and to compare the effects of ANP on these variables with those of equipotent infusion rates of sodium nitroprusside (SNP) (n = 9) 1-3 h after coronary artery bypass grafting (CABG). ANP induced a dose-dependent decrease in mean arterial blood pressure and systemic vascular resistance. There were no changes in cardiac index, heart rate, or cardiac filling pressures. ANP caused no changes in myocardial blood flow or its distribution, and caused no changes in myocardial oxygen extraction. Regional myocardial lactate uptake (RMLU) and extraction (RMLE) increased significantly (P < 0.05) at 50 ng [centered dot] kg-1 [centered dot] min-1 (10.2 +/- 3.8 micro mol/min and 8.2% +/- 3.0%, respectively) as compared to control (-1.1 +/- 3.0 micro mol/min and -1.3% +/- 3.3%, respectively). RMLE and RMLU were significantly (P < 0.05) higher with ANP (5.7% +/- 2.5% and 6.8 +/- 3.7 micro mol/min, respectively) compared to SNP (-1.5% +/- 2.1% and -0.1 +/- 3.7 micro mol/min, respectively). We conclude that ANP has no dilatory effects on coronary vascular resistance vessels and thus lacks the potential to maldistribute flow, and that ANP improves myocardial lactate metabolism after CABG. (Anesth Analg 1996;83:928-34)