Hostname: page-component-84b7d79bbc-5lx2p Total loading time: 0 Render date: 2024-07-31T09:46:31.143Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  19 August 2008

Henrik Holmström ,
Christian Hall ,
Oddvar Stokke ,
Harald Lindberg  and
Erik Thaulow
Henrik Holmström*
Affiliation:
Department of Pediatrics, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Christian Hall
Affiliation:
Institute for internal medicine research, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Oddvar Stokke
Affiliation:
Institute of clinical biochemistry, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Harald Lindberg
Affiliation:
Thoracal and cardiovascular surgery unit, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
Erik Thaulow
Affiliation:
Department of Pediatrics, National Hospital (Rikshospitalet), N-0027 Oslo, Norway
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Atrial natriuretic peptidecongenital heart diseasechildrenhemodynamicsprohormone
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 2 , March 1999 , pp. 141 - 149
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Nicholls, MG. Minisymposium: the natriuretic peptide hormones. Introduction. Editorial and historical review. J Intern Med 1994; 235: 507–514.CrossRefGoogle ScholarPubMed
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: 191–195.CrossRefGoogle Scholar
3.Ruskoaho, H. Atrial natriuretic peptide: synthesis, release, and metabolism. Pharmacol Rev 1922; 44: 479–602.Google Scholar
4.Nicholls, MG. The natriurutic peptides in heart failure. J Intern Med 1994; 235: 515–526.CrossRefGoogle ScholarPubMed
5.Nelesen, RA, Dimsdale, JE, Ziegler, MG. Plasma atrial natriuretic peptide is unstable under most storage conditions. Circlulation 1992; 86: 463—466.Google ScholarPubMed
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: 605–610.CrossRefGoogle ScholarPubMed
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: 41–49.CrossRefGoogle ScholarPubMed
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: 191–195.CrossRefGoogle ScholarPubMed
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: 1934–1942.CrossRefGoogle ScholarPubMed
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: 679–683.CrossRefGoogle ScholarPubMed
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: 1737–1746.CrossRefGoogle Scholar
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: 785–788.CrossRefGoogle ScholarPubMed
13.Uchiyama, M, Satokata, I, Aikawa, T, SAkai, K. Plasma atrial natriuretic peptide in congential heart disease. Acta Paediatr Scand 1987; 76: 669–670.CrossRefGoogle Scholar
14.Espiner, EA. Physiology of natriuretic perptides. J Intern Med 1994; 235: 527–541CrossRefGoogle Scholar
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: 380–384.CrossRefGoogle Scholar
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: 1328–1331.CrossRefGoogle ScholarPubMed
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: 1438–1445.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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: 639–643.CrossRefGoogle ScholarPubMed
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: 894–899.Google ScholarPubMed
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: 335–342.CrossRefGoogle ScholarPubMed
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: R1411–1417.Google ScholarPubMed
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: 578–580.CrossRefGoogle ScholarPubMed
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: 137–139.CrossRefGoogle ScholarPubMed
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: 235–239.CrossRefGoogle ScholarPubMed
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: 31–37.CrossRefGoogle ScholarPubMed
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: 288–2950.CrossRefGoogle ScholarPubMed
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: 703–707.CrossRefGoogle ScholarPubMed