Mangieri E, Tosti Croce C, Tanzilli G, Alessandri N, D'Agostino R, Pignatelli A, Lomurno A, Sardella G M, Nardi M, Scibilia G
Istituto di Chirurgia del Cuore e dei Grossi Vasi, Policlinico Umberto I, Università La Sapienza, Roma.
G Ital Cardiol. 1993 Nov;23(11):1115-23.
The recent introduction of percutaneous transvenous mitral valvuloplasty (PTMV) for the treatment of mitral stenosis (MS) has provided a unique human model for the study of short-term changes in ANF secretion before and after a reduction in left atrial pressure. This study was designed to investigate the effect of a short-term reduction in left atrial pressure and volume, as determined by echocardiographic study, on ANF and other neurohumoral factor plasma levels (renin and aldosterone).
10 patients in III FC NYHA, with normal sinus rhythm and MS underwent PTMV. Hemodynamic parameters were measured immediately before and after (20-30 minutes) PTMV. Plasma levels of ANF, aldosterone and plasma renin activity (PRA) were obtained before (24 h) and after (2 h and 24 h) valvuloplasty; echocardiographic left atrial size before (24 h) and 24 h after PTMV.
Immediately after PTMV mean left atrial (LA) pressure decreased from 22.3 +/- 6.8 mmHg to 10.0 +/- 2.4 mmHg (p < 0.01); mitral valve area (MVA) increased from 0.99 +/- 0.28 cm2 to 2.17 +/- 0.26 cm2 (p < 0.01). 24 hours after PTMV on echocardiography, LA systolic volume decreased from 59.5 +/- 16.9 cm3 to 42.3 +/- 8.3 cm3 (p < 0.01), LA diastolic volume from 82.6 +/- 15.8 cm3 to 66.5 +/- 12.6 cm3 (p < 0.01), and LA diameter from 48.1 +/- 7.5 mm to 39.2 +/- 4.4 mm (p < 0.01). ANF plasma levels before PTMV were 64.0 +/- 36.9 fmol/ml; 2 and 24 hours after PTMV they fell to 34.2 +/- 21.6 fmol/ml (p < 0.01) and to 20.3 +/- 21.0 fmol/ml (p < 0.01), respectively. PRA values were 15.7 +/- 13.2 ng/ml/h before PTMV; 2 and 24 hours after PTMV they increased to 17.5 +/- 23.2 ng/ml/h (NS) and to 22.3 +/- 16.8 ng/ml/h (p < 0.01). The aldosterone plasma levels were 43.2 +/- 27.9 ng/dl before PTMV and 47.3 +/- 35.8 ng/dl (NS) and 45.3 +/- 28.0 ng/dl (NS) 2 and 24 hours after PTMV.
These results indicate that LA "de-stretching" due to the MVA increase and LA pressure decrease, leads to an abrupt reduction of ANF secretion. According to other studies, PRA increases immediately after PTMV, with a further increase 24 hours after PTMV.
经皮经静脉二尖瓣成形术（PTMV）近期被用于治疗二尖瓣狭窄（MS），这为研究左心房压力降低前后心房钠尿肽（ANF）分泌的短期变化提供了独特的人体模型。本研究旨在通过超声心动图研究，探讨左心房压力和容积的短期降低对ANF及其他神经体液因子血浆水平（肾素和醛固酮）的影响。
10例纽约心脏协会（NYHA）心功能III级、窦性心律正常且患有MS的患者接受了PTMV。在PTMV前后（20 - 30分钟）立即测量血流动力学参数。在瓣膜成形术前（24小时）和术后（2小时及24小时）获取ANF、醛固酮的血浆水平及血浆肾素活性（PRA）；在PTMV前（24小时）和术后24小时测量超声心动图左心房大小。
PTMV后即刻，平均左心房（LA）压力从22.3±6.8 mmHg降至10.0±2.4 mmHg（p < 0.01）；二尖瓣瓣口面积（MVA）从0.99±0.28 cm²增加至2.17±0.26 cm²（p < 0.01）。PTMV后24小时的超声心动图显示，LA收缩末期容积从59.5±16.9 cm³降至42.3±8.3 cm³（p < 0.01）；LA舒张末期容积从82.6±15.8 cm³降至66.5±12.6 cm³（p < 0.01）；LA直径从48.1±7.5 mm降至39.2±4.4 mm（p < 0.01）。PTMV前ANF血浆水平为64.0±36.9 fmol/ml；PTMV后2小时和24小时分别降至34.2±21.6 fmol/ml（p < 0.01）和20.3±21.0 fmol/ml（p < 0.01）。PTMV前PRA值为15.7±13.2 ng/ml/h；PTMV后2小时和24小时分别增至17.5±23.2 ng/ml/h（无统计学意义）和22.3±16.8 ng/ml/h（p < 0.01）。PTMV前醛固酮血浆水平为43.2±27.9 ng/dl，PTMV后2小时和24小时分别为47.3±35.8 ng/dl（无统计学意义）和45.3±28.0 ng/dl（无统计学意义）。
这些结果表明，由于MVA增加和LA压力降低导致的LA“去拉伸”，会使ANF分泌突然减少。根据其他研究，PTMV后PRA立即升高，PTMV后24小时进一步升高。
