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European Heart Journal 1994 15(6):793-800;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Relationship of renin, angiotensin II and atrial natriuretic factor to clinical status in the early post-infarct period in patients with left ventricular dysfunction

S. G. RAY, J.J. MORTON* and H. J. DARGIE

Department of Cardiology, Western Infirmary Glasgow, U.K.
*Medical Research Council Blood Pressure Unit, Western Infirmary Glasgow, U.K.

Received 28 October 1993; revised 1 February 1994; .

Correspondence. Dr Simon G. Ray, Department of Cardiology, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, U K.

Abstract

The vasoconstrictor and cardiotoxic effects of angiotensin II may be particularly harmful in the early post-infarct period, but could be partially offset by the release of atrial natriuretic factor. We studied the relationship of renin, angiotensin II and atrial natriuretic factor to clinical status in the first 72 h after infarction in 36 patients not requiring treatment with diuretics on clinical grounds. Since these patients were treated with streptokinase, 16 non-thrombolysed patients were included to control for the acute effects of streptokinase on plasma hormones.

Streptokinase caused transient fluctuations in plasma renin and atrial natriuretic factor but did not limit the subsequent development of supranormal hormone levels. Streptokinase-treated patients were divided on the basis of the highest recorded Killip class. Activation of the renin angiotensin system occurred only in those patients in Killip class 2 (n=11), was maximal at 24–72 h and was proportional to the extent of left ventricular dysfunction. Plasma levels of atrial natriuretic factor were elevated on admission, even in patients in Killip class 1 (n=25), but declined within an hour before rising again to supranormal levels at 24–72 h. Cumulative release of renin and angiotensin II, but not atrial natriuretic factor, were significantly greater in patients in Killip class 2. Heart rate was greater in Killip class 2 at 24 and 72 h but there was no difference in mean arterial pressures.

We conclude that the renin angiotensin system is activated in the early post-infarction phase, but only in patients in Killip class 2, possibly as a result of increased sympathetic activity and reduced renal perfusion. Release of atrial natriuretic factor is less dependent on left ventricular dysfunction and follows a biphasic pattern, irrespective of streptokinase treatment.

Key Words: Myocardial infarction • atrial natriuretic factor • renin • angiotensin II • streptokinase


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