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European Heart Journal 1990 11(12):1065-1073;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Atrial natriuretic peptide response to postural changes in patients with left atrial hypertension

J. P. WOLF*, J. C. DUSSAULE*, A. VAHANIAN{dagger}, P. L. MICHEL{dagger}, J. ACAR{dagger} and R. ARDAILLOU*,

*INSERM 64 Research Unit, Hôpital Tenon Paris, France
{dagger}Department of Cardiology, Hôpital Tenon Paris, France

Received 18 August 1989; revised 11 December 1989; .

Address for reprints: R. Ardaillou, Hopital Tenon, 4 rue de la Chine, 75020 Paris, France

Abstract

Plasma atrial natriuretic peptide (ANP), cyclic guanosine monophosphate (GMP) and renin activity (PRA) were measured in 13 patients with mitral stenosis 24 h before and 48 h after balloon valvotomy resulting in a fall in LA pressure from 23.4 ± 2.2 to 10.5 ± 0.8 mmHg (P<0.01). Before treatment, plasma ANP was higher during ambulation (128.1 ± 18.5 pg ml–1) than in the supine posture (93.3± 15.0 pg ml–1; P<0.01) and did not diminish after return to the erect posture (86.4± 14.1 pg ml–1). A physiological response was restored after valvotomy with ANP plasma levels of 49.2 ± 7.8pg ml–1 in the initial ambulant period, 63.1 ± 12.6 pg ml–1 in the supine posture and 44.6 ± 8.7 pg ml–1 in the final erect posture. Postural variations of cyclic GMP were parallel to those of ANP. In contrast, LA hypertension did not abolish PRA postural response. During the three successive periods of ambulation, supine posture and erect posture PRA was 5.4± 10, 2.8 ± 0.6 and 5.5± 1.2ng h–1 ml–1, respectively, before treatment, whereas after treatment the values measured were 10.3 ± 2.9, 2.3 ± 0.7 and 7.0 ± 2.5 ngh–1 ml–1 respectively. Variations of plasma ANP, cyclic GMP and PRA in response to postural changes were also studied in 10 healthy volunteers and in 12 uraemic patients with high plasma ANP. Similar physiological results were obtained in these two control groups, suggesting that the dysregulation of ANP response in patients with high LA pressure was not related to the high values of plasma ANP. In conclusion, persistent elevation of plasma ANP in response to postural changes appears to be the consequence of LA hypertension.

Key Words: Mitral stenosis • atrial natriuretic peptide • atrial pressure • posture


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