Cody R J, Kubo S H, Laragh J H, Atlas S A
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
J Appl Physiol (1985). 1992 Oct;73(4):1637-43. doi: 10.1152/jappl.1992.73.4.1637.
We have previously reported a fivefold increase of plasma atrial natriuretic factor (ANF) in patients with congestive heart failure (CHF) compared with normal subjects. However, given the marked increase of ANF under basal conditions, the extent to which ANF secretion can further increase under physiological stress is not been clarified in CHF. We therefore evaluated ANF secretion during ergometric exercise in 11 patients with CHF, with peripheral venous ANF samples obtained at rest and peak exercise. In seven patients, simultaneous peripheral venous and right ventricular ANF samples were obtained to estimate myocardial ANF secretion. Hemodynamic characteristics of exercise included a significant increase of heart rate, mean arterial pressure, and cardiac output (all P < 0.01); reduction of systemic vascular resistance (P < 0.001); and increase of right atrial and pulmonary wedge pressures (P < 0.001). ANF was abnormally elevated at baseline (108 +/- 58 fmol/ml) yet increased further to 183 +/- 86 fmol/ml with exercise (P < 0.003). A step-up of right ventricular ANF, particularly during exercise, was consistent with active myocardial secretion, despite elevated baseline ANF levels.
我们之前报道过，与正常受试者相比，充血性心力衰竭（CHF）患者血浆心钠素（ANF）增加了五倍。然而，鉴于基础条件下ANF显著增加，CHF患者在生理应激状态下ANF分泌能进一步增加的程度尚未明确。因此，我们评估了11例CHF患者在运动试验期间的ANF分泌情况，在静息和运动峰值时采集外周静脉ANF样本。在7例患者中，同时采集外周静脉和右心室ANF样本以评估心肌ANF分泌。运动的血流动力学特征包括心率、平均动脉压和心输出量显著增加（均P<0.01）；全身血管阻力降低（P<0.001）；右心房和肺楔压升高（P<0.001）。ANF在基线时异常升高（108±58 fmol/ml），但运动时进一步升高至183±86 fmol/ml（P<0.003）。尽管基线ANF水平升高，但右心室ANF升高，尤其是在运动期间，这与心肌的活跃分泌一致。
