Kula Serdar, Tunaoglu F Sedef, Olgunturk Rana, Gokcora Nahide
Department of Pediatric Cardiology, Gazi University, Ankara, Turkey.
Can J Cardiol. 2003 Mar 31;19(4):405-8.
Rheumatic mitral regurgitation (MR) causes heart failure by volume overload and an increase in atrial natriuretic peptide (ANP) levels by atrial stretching. Symptoms of heart failure improve with ANP treatment. Angiotensin-converting enzyme inhibitors (ACEI) and ANP have similar effects, such as vasodilation, natriuresis and diuresis.
To determine ANP levels and response to ACEI treatment in children with rheumatic MR.
Patients with rheumatic MR were divided into two groups: the digoxin group (10 girls, two boys; age range 10 to 18 years, mean 14 +/- 0.72 years; taking digoxin for at least one year) and the control group (eight girls, four boys; age range eight to 17 years, mean 13.5 +/- 0.81 years). None of the patients in either group had symptoms of heart failure. Serum ANP levels, left ventricular systolic functions, and mitral and aortic stroke volumes of both groups were evaluated on admission. The digoxin group was given ACEI and re-evaluated on the 20th day of treatment.
At baseline, ANP levels were higher in the digoxin group (27.3 +/- 6.5 pg/100 microL) than in the control group (6.9 +/- 0.9 pg/100 microL) (P<0.05). On the 20th day of treatment, there were no significant differences in the ANP levels of the digoxin (13.2 +/- 6.1 pg/100 microL) and control groups. There was a significant decrease in ANP levels in the digoxin group between baseline and the 20th day of therapy. Mitral stroke volumes (510.4 +/- 92.8 mL/m2) and left ventricular diastolic volume (108 +/- 12 mL/m2) in the digoxin group at baseline were higher than those in the control group (315.3 +/- 59.9 mL/m2 and 82 +/- 6.5 mL/m2, respectively) on admission; on the 20th day of treatment, there were no significant differences in these values. At baseline, aortic stroke volume in the digoxin and control groups were 86.9 +/- 59.1 and 82.9 +/- 28.3 mL/m2, respectively (P>0.05). On the 20th day of therapy, the aortic stroke volume of digoxin group had increased to 104.7 +/- 70.1 mL/m2, significantly higher than that of the control group.
ANP levels are a good indicator of volume overload. ACEI should be introduced at an early stage of rheumatic MR because, even if patients are taking digoxin, their heart failure may progress silently.
风湿性二尖瓣反流（MR）通过容量超负荷导致心力衰竭，并因心房牵张使心房利钠肽（ANP）水平升高。心力衰竭症状通过ANP治疗可得到改善。血管紧张素转换酶抑制剂（ACEI）与ANP具有相似作用，如血管舒张、利钠和利尿。
确定风湿性MR患儿的ANP水平及对ACEI治疗的反应。
风湿性MR患者分为两组：地高辛组（10名女孩，2名男孩；年龄范围10至18岁，平均14±0.72岁；服用地高辛至少1年）和对照组（8名女孩，4名男孩；年龄范围8至17岁，平均13.5±0.81岁）。两组患者均无心衰症状。入院时评估两组患者的血清ANP水平、左心室收缩功能以及二尖瓣和主动脉搏出量。地高辛组给予ACEI，并在治疗第20天进行重新评估。
基线时，地高辛组的ANP水平（27.3±6.5 pg/100微升）高于对照组（6.9±0.9 pg/100微升）（P<0.05）。治疗第20天，地高辛组（13.2±6.1 pg/100微升）与对照组的ANP水平无显著差异。地高辛组从基线到治疗第20天ANP水平显著降低。地高辛组基线时的二尖瓣搏出量（510.4±92.8 mL/m²）和左心室舒张末期容积（108±12 mL/m²）高于入院时对照组（分别为315.3±59.9 mL/m²和82±6.5 mL/m²）；治疗第20天，这些值无显著差异。基线时，地高辛组和对照组的主动脉搏出量分别为86.9±59.1和82.9±28.3 mL/m²（P>0.05）。治疗第20天，地高辛组的主动脉搏出量增加至104.7±70.1 mL/m²，显著高于对照组。
ANP水平是容量超负荷的良好指标。风湿性MR应在早期引入ACEI治疗，因为即使患者正在服用地高辛，其心力衰竭仍可能悄然进展。
