Geny B, Piquard F, Follenius M, Petit H, Levy F, Epailly E, Kretz J G, Eisenmann B, Haberey P
Laboratoire d'Explorations Fonctionnelles du Système Circulatoire, Faculté de Médecine Strasbourg, France.
Eur J Appl Physiol Occup Physiol. 1996;72(5-6):440-4. doi: 10.1007/BF00242273.
The increase in plasma concentration of atrial natriuretic factor in heart transplant patients has not been fully elucidated. Besides an eventual pressure or volume overload leading to passive atrial distension, the atrial tension developed during atrial systole, or atrial ejection force, which may be increased by the transplantation procedure, is an important determinant of atrial natriuretic factor release. We therefore determined the plasma concentration of atrial natriuretic factor and the maximal atrial ejection force in 15 heart transplant patients and 8 controls, matched for age and body mass. Atrial ejection force, as defined as the force exerted by the left atrium to accelerate blood into the left ventricle during atrial systole, was obtained using combined two-dimensional imaging and doppler echocardiography. Serum creatinin concentrations, heart rate [91.9 (SD 13.2) vs 71.8 (SD 10.9) beats.min-1], mean arterial blood pressure [103.9 (SD 9.8) vs 87.4 (SD 5.8) mmHg, 13.85 (SD 1.31) vs 11.65 (SD 0.77) kPa], left ventricular posterior wall thickness and interventricular septum thickness were higher in heart transplant patients compared to controls. Plasma concentration of atrial natriuretic factor was also elevated in heart transplant patients [63.9 (SD 18.1) vs 34.0 (SD 3.2) pg.ml-1; P < 0.001]. In contrast, although the left atrial area was greater in heart transplant patients [28.2 (SD 4.8) vs 15.8 (SD 2.5) cm2; P < 0.001], mitral area, transmitral Doppler A-wave maximal velocity and atrial ejection force were similar in transplant and in control patients [7.7 (SD 3.5) vs 8.9 (SD 2.8) kdyn, 77 (SD 35) vs 89 (SD 28)mN]. No significant correlation was observed between concentration of atrial natriuretic factor and atrial ejection force, either in heart transplant patients or in controls. Thus, the elevated plasma concentration of atrial natriuretic factor observed in these heart transplant patients was multifactorial in origin, and was considered to depend upon an hypersecretion rather than upon a decreased clearance rate. Moreover, it is suggested that the atrial ejection force was unlikely to have participated in this enhanced release of atrial natriuretic factor.
心脏移植患者血浆心钠素浓度升高的原因尚未完全阐明。除了最终的压力或容量超负荷导致心房被动扩张外，心房收缩期产生的心房张力或心房射血力（可能因移植手术而增加）是心钠素释放的重要决定因素。因此，我们测定了15例心脏移植患者和8例年龄及体重匹配的对照组的血浆心钠素浓度和最大心房射血力。心房射血力定义为心房收缩期左心房将血液加速射入左心室所施加的力，采用二维成像和多普勒超声心动图联合测定。心脏移植患者的血清肌酐浓度、心率[91.9（标准差13.2）对71.8（标准差10.9）次/分钟]、平均动脉血压[103.9（标准差9.8）对87.4（标准差5.8）mmHg，13.85（标准差1.31）对11.65（标准差0.77）kPa]、左心室后壁厚度和室间隔厚度均高于对照组。心脏移植患者的血浆心钠素浓度也升高[63.9（标准差18.1）对34.0（标准差3.2）pg/ml；P<0.001]。相比之下，尽管心脏移植患者的左心房面积更大[28.2（标准差4.8）对15.8（标准差2.5）cm²；P<0.001]，但移植患者和对照患者的二尖瓣面积、二尖瓣多普勒A波最大速度和心房射血力相似[7.7（标准差3.5）对8.9（标准差2.8）kdyn，77（标准差35）对89（标准差28）mN]。在心脏移植患者或对照组中，均未观察到心钠素浓度与心房射血力之间存在显著相关性。因此，这些心脏移植患者中观察到的血浆心钠素浓度升高是多因素的，被认为取决于分泌过多而非清除率降低。此外，提示心房射血力不太可能参与心钠素的这种增强释放。
