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Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide

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Abstract

Purpose

Aldosterone prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide (ANP), a circulating hormone of cardiac origin, inhibits aldosterone synthase gene expression in cultured cardiocytes. We evaluated the effects of intravenous ANP on cardiac sympathetic nerve activity (CSNA) and aldosterone suppression in patients with acute decompensated heart failure (ADHF).

Methods

We studied 182 patients with moderate nonischemic ADHF requiring hospitalization and treated with standard therapy containing intravenous ANP and 10 age-matched normal control subjects. ANP was continuously infused for >96 h. In all subjects, delayed total defect score (TDS), heart to mediastinum ratio, and washout rate were determined by 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Left ventricular (LV) end-diastolic volume, end-systolic volume, and ejection fraction were determined by echocardiography. All patients with acute heart failure (AHF) were examined once within 3 days and then 4 weeks after admission, while the control subjects were examined only once (when their hemodynamics were normal). Moreover, for 62 AHF patients, plasma aldosterone concentrations were measured at admission and 1 h before stopping ANP infusion.

Results

123I-MIBG scintigraphic and echocardiographic parameters in normal subjects were more favorable than those in patients with AHF (all p < 0.001). After treatment, all these parameters improved significantly in AHF patients (all p < 0.001). We also found significant correlation between percent changes of TDS and aldosterone concentrations (r = 0.539, p < 0.001) in 62 AHF patients.

Conclusion

The CSNA and LV performance were all improved in AHF patients. Furthermore, norepinephrine uptake of myocardium may be ameliorated by suppressing aldosterone production after standard treatment containing intravenous ANP.

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Authors and Affiliations

  1. Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma, 371-0034, Japan

    Shu Kasama, Takuji Toyama & Masahiko Kurabayashi

  2. Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan

    Shu Kasama, Toshiya Iwasaki, Hiroyuki Sumino, Hisao Kumakura, Kazutomo Minami & Shuichi Ichikawa

  3. Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan

    Naoya Matsumoto

  4. Second (Cardiology) Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan

    Tomoaki Nakata

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  1. Shu Kasama
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Correspondence to Shu Kasama.

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Kasama, S., Toyama, T., Iwasaki, T. et al. Evaluation of cardiac sympathetic nerve activity and aldosterone suppression in patients with acute decompensated heart failure on treatment containing intravenous atrial natriuretic peptide. Eur J Nucl Med Mol Imaging 41, 1683–1691 (2014). https://doi.org/10.1007/s00259-014-2754-2

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  • DOI: https://doi.org/10.1007/s00259-014-2754-2

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