Donckier J E, De Coster P M, Vanoverschelde J L, Brichant C, Cauwe F, Installe E, Berbinschi A, Ketelslegers J M, Marchandise B
Division of Internal Medicine, University of Louvain, University Hospital UCL of Mont-Godinne, Yvoir, Belgium.
Eur Heart J. 1991 Mar;12(3):332-7. doi: 10.1093/oxfordjournals.eurheartj.a059898.
To study the mechanism of atrial natriuretic factor (ANF) release in heart failure, we measured plasma ANF concentrations, cardiac volumes and filling pressures at rest and during three graded exercise levels (E1, E2, E3) in six male patients with congestive heart failure (CHF) and compared them with 13 normal male subjects. At rest, ANF concentrations were sixfold higher in patients with CHF than in normal subjects (at rest: 53 +/- 12 vs 8 +/- 1 pmol.l-1; P less than 0.02). End-systolic ventricular volumes were increased threefold in patients with CHF (P less than 0.02) despite normal mean central venous pressure, pulmonary artery pressure (PAP) and pulmonary wedge pressure (PWP). A positive correlation was found between end-systolic ventricular volumes and plasma ANF (r = 0.93, P less than 0.001). During exercise, ANF rose by 120% over basal values both in patients with CHF and in normal subjects (P less than 0.01). Volumes higher than normal in patients with CHF increased further at E2 (P less than 0.05) in contrast to a decrease of systolic volumes recorded in normal subjects (P less than 0.05). Filling pressures rising abnormally in patients with CHF correlated with plasma ANF during exercise (r = 0.53, P less than 0.02 for PAP; r = 0.51, P less than 0.05 for PWP). In conclusion, our data suggest that ANF release in CHF is regulated at rest by cardiac volumes when filling pressures are still normal. During exercise, ANF release is not impaired in CHF with normal rest filling pressures and is regulated during exercise by left filling pressures.
为研究心力衰竭时心房利钠因子（ANF）释放的机制，我们测量了6名充血性心力衰竭（CHF）男性患者静息状态下及三个分级运动水平（E1、E2、E3）时的血浆ANF浓度、心脏容积和充盈压，并将其与13名正常男性受试者进行比较。静息时，CHF患者的ANF浓度比正常受试者高6倍（静息时：53±12 vs 8±1 pmol·l-1；P<0.02）。尽管平均中心静脉压、肺动脉压（PAP）和肺楔压（PWP）正常，但CHF患者的收缩末期心室容积增加了3倍（P<0.02）。收缩末期心室容积与血浆ANF之间呈正相关（r = 0.93，P<0.001）。运动期间，CHF患者和正常受试者的ANF均比基础值升高120%（P<0.01）。与正常受试者收缩期容积减少（P<0.05）相反，CHF患者高于正常的容积在E2时进一步增加（P<0.05）。CHF患者异常升高的充盈压与运动期间的血浆ANF相关（PAP的r = 0.53，P<0.02；PWP的r = 0.51，P<0.05）。总之，我们的数据表明，在充盈压仍正常时，CHF中ANF的释放静息时受心脏容积调节。运动期间，静息充盈压正常的CHF患者ANF释放未受损，且运动期间受左心室充盈压调节。
