Kurisu Satoshi, Fujiwara Hitoshi
Department of Cardiology, National Hospital Organization (NHO) Hiroshimanishi Medical Center, Otake, JPN.
Cureus. 2024 Oct 19;16(10):e71844. doi: 10.7759/cureus.71844. eCollection 2024 Oct.
Atrial natriuretic peptide (ANP) is a circulating hormone released from the atria in response to wall stretch and volume overload in the setting of heart failure. When atrial fibrillation (AF) becomes long-standing persistent, ANP secretion in response to volume overload is impaired due to degenerative changes of the atria. Here, we report a case of heart failure with preserved ejection fraction and impaired ANP secretion due to long-standing AF. N-terminal pro-brain natriuretic peptide (NT-proBNP) level was elevated (269 pg/mL), whereas the increase in ANP level was marginal (46.1 pg/mL), suggesting impaired ANP secretion due to long-standing AF. Valsartan (80 mg/day) was replaced with sacubitril/valsartan (100 mg/day) without changing other medications. Administration of sacubitril/valsartan was effective in improving the patient's symptoms, such as dyspnea and edema, and reducing NT-proBNP level by increasing endogenous ANP level from 46.1 pg/mL to 117 pg/mL in the first four weeks. This case highlights the possibility of impaired ANP secretion in response to volume overload as a predictor of the diuretic effect of sacubitril/valsartan in heart failure. This may lead to individualized treatment for each patient with heart failure based on natriuretic peptide profiles.
心房利钠肽（ANP）是一种循环激素，在心力衰竭时，心房会因壁张力增加和容量超负荷而释放该激素。当房颤（AF）发展为长期持续性房颤时，由于心房的退行性改变，心房对容量超负荷的反应中ANP分泌受损。在此，我们报告一例射血分数保留的心力衰竭患者，其因长期房颤导致ANP分泌受损。N端前脑利钠肽（NT-proBNP）水平升高（269 pg/mL），而ANP水平仅略有升高（46.1 pg/mL），提示长期房颤导致ANP分泌受损。在未改变其他药物的情况下，将缬沙坦（80 mg/天）换为沙库巴曲缬沙坦（100 mg/天）。给予沙库巴曲缬沙坦可有效改善患者的症状，如呼吸困难和水肿，并在前四周内通过将内源性ANP水平从46.1 pg/mL提高到117 pg/mL来降低NT-proBNP水平。该病例凸显了容量超负荷时ANP分泌受损作为沙库巴曲缬沙坦对心力衰竭利尿作用预测指标的可能性。这可能会根据利钠肽谱为每位心力衰竭患者制定个体化治疗方案。
