Skip to main content Accessibility help
×
Home

Elevation of atrial natriuretic peptide prohormone. Hemodynamic background of the elevation of N-terminal natriuretic peptide prohormone in children with congenital heart disease

  • Henrik Holmström (a1), Christian Hall (a2), Oddvar Stokke (a3), Harald Lindberg (a4) and Erik Thaulow (a1)...

Abstract

We postulated previously that variables related to pulmonary flow are independent predictors of levels of atrial natriuretic peptide in children with congenital heart disease. The aim of this study was to test this hypothesis in relation to other hemodynamic and clinical variables.

During catheterization we measured the levels of plasma N-terminal atrial natriuretic peptide prohormone in the plasma of 68 children with congenital heart disease. All had undergone complete clinical, echocardiographic and invasive hemodynamic investigations. The influence on the prohormone was analyzed for 10 different variables in a multiple linear regression model. The variability could be explained in large parts (adjusted R2 = 77.2%) by variations in atrial pressures or sizes, together with the degree of excessive pulmonary blood flow and signs of heart failure.

A value for atrial natriuretic peptide prohormone above 800 pmol/1 predicted hemodynamic imbalance (defined as elevated pressures in left or right atrium or the pulmonary arteries, and/or Qp/Qs > 1.5) with a specificity of 94%, a sensitivity of 73%, a positive likelihood ratio of 12.2, and a negative likelihood ratio of 0.29.

In conclusion, variables related to pulmonary blood flow are influential determinants of the levels of atrial natriureic peptide in children with congenital heart disease. Atrial pressures, and symptoms of heart failure are also of major importance.

Copyright

Corresponding author

Henrik Holmström, Barnehjerteseksjonen, Rikshospitalet (National hospital), N-0027 Oslo, Norway. Tel: 47-22 86 90 95; Fax: 47-22 86 9101; e-mail: henrik.holmstrom@rh.uio.no

References

Hide All
1.Nicholls, MG. Minisymposium: the natriuretic peptide hormones. Introduction. Editorial and historical review. J Intern Med 1994; 235: 507514.
2.Edwards, BS, Zimmerman, RS, Schwab, TR, Heublein, DM, Burnett, JC. Jt. Atrial stretch, not pressure, is the principal determinant controlling the acute relase of atrial natriuretic factor. Circ Res 1988; 62: 191195.
3.Ruskoaho, H. Atrial natriuretic peptide: synthesis, release, and metabolism. Pharmacol Rev 1922; 44: 479602.
4.Nicholls, MG. The natriurutic peptides in heart failure. J Intern Med 1994; 235: 515526.
5.Nelesen, RA, Dimsdale, JE, Ziegler, MG. Plasma atrial natriuretic peptide is unstable under most storage conditions. Circlulation 1992; 86: 463—466.
6.Sundsfjord, JA, Thibault, G, Larochelle, P, Cantin, M. Identification and plasma concentrations of the N–terminal fragment of proatrial natriuretic factor in man. J Clin Endocrinol Metab 1988; 66: 605610.
7.Mathisen, P, Hall, C, Simonesen, S. Comparative study of atrial peptides ANF (1–98) and ANF (99–126) as diagnostic markers of atrial distension in patients with cardiac disease. Scand J Clin Lab Invest 1993; 53: 4149.
8.Hall, C, Kjekshus, J, Eneroth, P, Snapinn, S. The plasma concentration of N–terminal proatrial natriuretic factor ANF(1—98) is related to prognosis in severe heart failure. Clin Cardiol 1994; 17: 191195.
9.Hall, C, Rouleau, JL, Moye, L, de, Champlain J, Bichet, D, Klein, M, Sussex, B, Packer, M, Rouleau, J, Arnold, MO, et al. N–terminal proatrial natriuretic factor. An independent predictor of long–term prognosis after myocardial infarction. Circulation 1994; 89: 19341942.
10.Dickstein, K, Larsen, AI, Bonarjee, V, Thoresen, M, Aarsland, T, Hall, C. Plasma proatrial natriuretic factor is predictive of clinical status in patients with congestive heart failure. Am J Cardiol 1995; 76: 679683.
11.Holmstrom, H, Thaulow, E, Stokke, O, Lindberg, H, and Hall, C. Serum N–terminal proatrial natrial natriuretic factor in childern with congenital heart disease. European Heart Journal 1996: 17: 17371746.
12.Ross, RD, Daniels, SR, Dolan, LM, Young, CA, Meyer, RA. Determinants of plasma atrial natriuretic factor concentrations in congenital heart disease. Am J Cardiol 1988; 62: 785788.
13.Uchiyama, M, Satokata, I, Aikawa, T, SAkai, K. Plasma atrial natriuretic peptide in congential heart disease. Acta Paediatr Scand 1987; 76: 669670.
14.Espiner, EA. Physiology of natriuretic perptides. J Intern Med 1994; 235: 527541
15.Kikuchi, K, Shiomi, M, Horie, K, Ohie, T, Nakao, K, Imura, H, Mikawa, H. Plasma atrial natriuretic polypeptide concentration in healthy childern from birth to adolescence. Acta Paediatr Scand 1988; 77: 380384.
16.Weil, J, Bidlingmaier, F, Dohlemann, C, Kuhnle, U, Strom, T, Lang, RE. Comparison of plasma atrial natriuretic peptide levels in healthy children from birth to adolescence and in children with cardiac diseases. Pediatr Res 1986; 20: 13281331.
17.Oberhansli, I, Mermillod, B, Favre, H, Friedli, B, Girardin, E, Paunier, L. Atrial natriuretic factor in patients with congenital heart disease: correlation with hemodynamic variables. J Am Coll Cardiol 1990; 15: 14381445.
18.Nugent, AM, Onuoha, GN, McEneaney, DJ, Steele, IC, Hunter, SJ, Prasanna, K, Campbell, NP, Shaw, C, Buchanan, KD, Nicholls, DP. Variable patterns of atrial natriuretic peptide secretion in man. Eur J Clin Invest 1994; 24: 261–21 A.
19.Matsuoka, S, Kurahashi, Y, Miki, Y, Miyao, M, Yamazaki, Y, Nishiuchi, T, Saito, S. Plasma atrial natriuretic peptide in patients with congenital heart diseases. Pediatrics 1988; 82: 639643.
20.Levin, AR, Liebson, PR, Ehlers, KH, Diamant, B. Assessment of left ventricular function in secundum atrial septal defect: evaluation by determination of volume, pressure, and external systolic time indices. Pediatr Res 1975; 9: 894899.
21.Kikuchi, K, Nishioka, K, Ueda, T, Shiomi, M, Takahashi, Y, Sugawara, A, Nakao, K, Imura, H, Mori, C, Mikawa, H. Relationship between plasma atrial natriuretic polypeptide concentration and hemodynamic measurements in children with congenital heart diseases. J Pediatr 1987; 111: 335342.
22.Javeshghani, D, Mukaddam, Daher S, Fan, L, Guan, Z, Gutkowska, J, Nuwayhid, B, Quillen, EW Jr. Control of atrial natriuretic factor by right and left atrial distension in pregnant sheep. Am J Physiol 1995; 268: R14111417.
23.Matsuoka, S, Kurahashi, Y, Tomimatsu, H, Miyao, M, Yamazaki, Y, Nishiuchi, T, Saito, S. Plasma atrial natriuretic peptide levels in patients with ventricular septal defect. J Pediatr 1987; 110: 578580.
24.Pesonen, E, Merritt, AT, Heldt, G, Sahn, DJ, Elias, W, Tikkanen, I, Fyhrquist, F, Andersson, S. Correlation of patent ductus arteriosus shunting with plasma atrial natriuretic factor concentration in preterm infants with respiratory distress syndrome. Pediatr Res 1990; 27: 137139.
25.Kaapa, P, Seppanen, M, Kero, P, Ekblad, H, Arjamaa, O, Vuolteenaho, O. Hemodynamic control of atrial natriuretic peptide plasma levels in neonatal respiratory distress syndrome. Am J Perinatol 1995; 12: 235239.
26.Burghuber, OC, Hartter, E, Punzengruber, C, Weissel, M, Woloszczuk, W. Human atrial natriuretic peptide secretion in precapillary pulmonary hypertension. Clinical study in patients with COPD and interstitial fibrosis. Chest 1988; 93: 3137.
27.Tunaoglu, FS, Olgunturk, FR, Gokcora, N, Turkyilmaz, C, Gurbuz, F. Atrial natriuretic peptide concentrations in children with pulmonary hypertension: correlation with hemodynamic measurements. Pediatr Cardiol 1994; 15: 2882950.
28.Jaeschke, R, Guyatt, G, Sackett, D. User's guides to medical literature. How to use an article about a diagnostic test. What are the results, and will they help me in caring for my patients?; JAMA 1994; 271: 703707.

Keywords

Elevation of atrial natriuretic peptide prohormone. Hemodynamic background of the elevation of N-terminal natriuretic peptide prohormone in children with congenital heart disease

  • Henrik Holmström (a1), Christian Hall (a2), Oddvar Stokke (a3), Harald Lindberg (a4) and Erik Thaulow (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed