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Differential regulation of atrial and brain natriuretic peptides and its implications for the management of left ventricular volume overload
Author(s) -
Dzimiri N.,
Moorji A.,
Afrane B.,
AlHalees Z.
Publication year - 2002
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1046/j.1365-2362.2002.01035.x
Subject(s) - ventricle , medicine , brain natriuretic peptide , cardiology , atrium (architecture) , atrial natriuretic peptide , volume overload , natriuretic peptide , heart failure , endocrinology , atrial fibrillation
Background In this study, we investigated the possibility that the atrial and brain natriuretic peptide expression in left ventricular volume overload (VOL) is transcriptionally regulated. We further evaluated the diagnostic and/or prognostic potential of this expression for the management of patients with this disorder. Design We compared the myocardial mRNA expression and plasma levels of the two peptides in VOL patients using donor hearts and in healthy blood donors as controls. Results The atrial natriuretic peptide (ANP) mRNA was elevated by 38% ( P < 0·03) in the right atrium and by 53% ( P < 0·003) in the left atrium, but was unchanged in the ventricular chambers of the patient group ( n = 19) compared with controls ( n = 8). Plasma ANP concentration was elevated by 62% ( P < 0·001) compared with blood donor controls ( n = 79). It increased slightly (by 36%) 2 h following surgery, and remained at 64% higher ( P < 0·03 vs. presurgery) for the 5 days following surgery. The brain natriuretic peptide (BNP) mRNA was elevated by approximately one‐fold in both the left ventricle ( P < 0·02) and right atrium ( P < 0·05), by 94% ( P < 0·02) in the right ventricle and by 89% ( P < 0·05) in the left atrium. Its plasma level in the patients was 3·4‐fold ( P < 0·00003) higher than in control subjects. It increased significantly by 1·2‐fold ( P < 0·01) 2 h following surgery, but dropped significantly ( P < 0·05 vs. 2 h post surgery) to presurgical levels 5 days following surgery. Conclusion The results show chamber‐specific elevation in both atrial and brain natriuretic peptide expression and differences in their circulating levels in VOL, suggesting that BNP is a potential prognostic indicator in the postsurgical management of these patients.