June 1, 1992Open Access
Atrial natriuretic peptide and urinary cyclic guanosine monophosphate in patients with chronic heart failure.
Key Result
Heart failure patients had significantly elevated plasma hANP (139.0 vs 22.0 pg/mL, P<0.05) and urinary cGMP excretion rates (1.14 vs 0.35 nmol/min, P<0.05) compared to normal controls.
Study Design
Type
Observational (n=10)
Structured PICO
Are plasma hANP and urinary cGMP levels elevated and correlated in patients with chronic heart failure?
P
Population
10 subjects, including 6 with NYHA class II-IV heart failure on no medications and 4 normal controls, evaluated for plasma hANP and urinary cGMP.
C
Comparator
Normal subjects
O
Outcome
Plasma human atrial natriuretic peptide (hANP) and urinary cyclic guanosine monophosphate (cGMP) concentrations and their correlationsurrogate
Plasma hANP and urinary cGMP are elevated and strongly correlated in heart failure patients, supporting cGMP as the second messenger for hANP in vivo.
Main Result
Absolute Event Rate: 139% vs 22%
p-value: p=<0.05
Abstract
Circulating concentrations of human atrial natriuretic peptide (hANP) are elevated in patients with heart failure; however, the natriuretic effect of hANP is blunted in these patients. In this study, the relationship between urinary cGMP, the second messenger for the natriuretic effect of hANP in vivo, and endogenous hANP was examined in six patients with heart failure and four normal subjects. In addition, right heart catheterization for the determination of central hemodynamics was performed in the heart failure patients. The heart failure patients were in New York Heart Association Classes II to IV and were receiving no medications at the time of the study. Supine plasma hANP and urinary cGMP concentrations were determined on two occasions in each subject, as were right and left atrial pressures in the heart failure patients. At the time of study, the patients were in positive sodium balance, and control subjects were in normal sodium balance. Plasma hANP and urinary cGMP excretion rates were elevated in heart failure patients as compared with those in controls: hANP, 139.0 +/- 42.0 versus 22.0 +/- 6.1 pg/mL (P less than 0.05); urinary cGMP, 1.14 +/- 0.31 versus 0.35 +/- 0.05 nmol/min (P less than 0.05). In heart failure patients, right atrial pressure correlated positively with plasma hANP (r = 0.96; P less than 0.01) and urinary cGMP concentrations (r = 0.93; P less than 0.05) and the excretion rate (r = 0.92; P less than 0.05). Moreover, plasma hANP was strongly correlated with urinary cGMP concentration (r = 0.91; P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)