Influence of dilated cardiomyopathy, myocarditis and cardiac transplantation on the relation between plasma atrial natriuretic factor and atrial pressures

Joshua Hare, Kenneth L. Baughman, David A. Kass, Steven N. Goodman, Paul W. Ladenson

Research output: Contribution to journalArticle

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Abstract

To determine whether dilated cardiomyopathy, myocarditis or cardiac transplantation affect the relation between plasma immunoreactive atrial natriuretic factor (ANF) and cardiac filling pressures, right atrial plasma ANF concentration, pulmonary arterial wedge pressure and right atrial pressure were measured in patients with dilated cardiomyopathy (n = 48), dilated cardiomyopathy secondary to myocarditis (n = 20) and prior cardiac transplantation (n = 34). ANF level significantly correlated with both pulmonary arterial wedge and right atrial pressures in patients with dilated cardiomyopathy; however, the presence or absence of myocarditis did not significantly alter these relations (p = 0.88 and p = 0.33 for interaction terms, respectively). For the combined group the ANF-pulmonary arterial wedge pressure relation had a slope of 8.1 pg/ ml/mm Hg (95% confidence interval (CI), 5.4 to 10.8; p = 0.0001) and the ANF-right atrial pressure relation a slope of 13.6 pg/ml/mm Hg (CI, 8.5 to 18.7; p = 0.0001). Receiver operator curve analysis identified an optimal dividing point of ANF 150 pg/ml with 100% (CI, 72 to 100%) of patients with right atrial pressure ≥ 8 mm Hg having ANF ≥ 150 pg/ml, but only 56% (CI, 42 to 69%) with pressure < 8 mm Hg having ANF < 150 pg/ml. Unlike the patients with cardiomyopathy (with or without myocarditis), cardiac transplant recipients displayed no correlation between ANF level and either pulmonary arterial wedge pressure (p = 0.50) or right atrial pressure (p = 0.29) despite similarly elevated ANF concentrations (mean ± standard deviation, 168 (83) pg/ml in transplant patients versus 185 (114) pg/ml in cardiomyopathy patients). It is concluded that left and right intracardiac pressures are important determinants of circulating ANF level unaffected by inflammation in patients with cardiomyopathy. Factors other than filling pressures influence circulating ANF in a significant number of patients with cardiomyopathy and in all transplant recipients.

Original languageEnglish
Pages (from-to)391-397
Number of pages7
JournalThe American journal of cardiology
Volume67
Issue number5
DOIs
StatePublished - Feb 15 1991
Externally publishedYes

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Atrial Pressure
Myocarditis
Dilated Cardiomyopathy
Atrial Natriuretic Factor
Heart Transplantation
Cardiomyopathies
Pulmonary Wedge Pressure
Confidence Intervals
Arterial Pressure
Pressure
Patient Rights

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Influence of dilated cardiomyopathy, myocarditis and cardiac transplantation on the relation between plasma atrial natriuretic factor and atrial pressures. / Hare, Joshua; Baughman, Kenneth L.; Kass, David A.; Goodman, Steven N.; Ladenson, Paul W.

In: The American journal of cardiology, Vol. 67, No. 5, 15.02.1991, p. 391-397.

Research output: Contribution to journalArticle

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abstract = "To determine whether dilated cardiomyopathy, myocarditis or cardiac transplantation affect the relation between plasma immunoreactive atrial natriuretic factor (ANF) and cardiac filling pressures, right atrial plasma ANF concentration, pulmonary arterial wedge pressure and right atrial pressure were measured in patients with dilated cardiomyopathy (n = 48), dilated cardiomyopathy secondary to myocarditis (n = 20) and prior cardiac transplantation (n = 34). ANF level significantly correlated with both pulmonary arterial wedge and right atrial pressures in patients with dilated cardiomyopathy; however, the presence or absence of myocarditis did not significantly alter these relations (p = 0.88 and p = 0.33 for interaction terms, respectively). For the combined group the ANF-pulmonary arterial wedge pressure relation had a slope of 8.1 pg/ ml/mm Hg (95{\%} confidence interval (CI), 5.4 to 10.8; p = 0.0001) and the ANF-right atrial pressure relation a slope of 13.6 pg/ml/mm Hg (CI, 8.5 to 18.7; p = 0.0001). Receiver operator curve analysis identified an optimal dividing point of ANF 150 pg/ml with 100{\%} (CI, 72 to 100{\%}) of patients with right atrial pressure ≥ 8 mm Hg having ANF ≥ 150 pg/ml, but only 56{\%} (CI, 42 to 69{\%}) with pressure < 8 mm Hg having ANF < 150 pg/ml. Unlike the patients with cardiomyopathy (with or without myocarditis), cardiac transplant recipients displayed no correlation between ANF level and either pulmonary arterial wedge pressure (p = 0.50) or right atrial pressure (p = 0.29) despite similarly elevated ANF concentrations (mean ± standard deviation, 168 (83) pg/ml in transplant patients versus 185 (114) pg/ml in cardiomyopathy patients). It is concluded that left and right intracardiac pressures are important determinants of circulating ANF level unaffected by inflammation in patients with cardiomyopathy. Factors other than filling pressures influence circulating ANF in a significant number of patients with cardiomyopathy and in all transplant recipients.",
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