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European Heart Journal Advance Access originally published online on May 19, 2008
European Heart Journal 2008 29(12):1485-1494; doi:10.1093/eurheartj/ehn206
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Effect of atrial natriuretic peptide on left ventricular remodelling in patients with acute myocardial infarction

Shu Kasama1,*, Mayumi Furuya2, Takuji Toyama1, Shuichi Ichikawa3 and Masahiko Kurabayashi1

1 Department of Cardiovascular Medicine, Gunma University School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan
2 Pharmacology and Toxicology Department, Asubio Pharma Co., Ltd, Osaka, Japan
3 Department of Internal Medicine, Cardiovascular Hospital of Central Japan, Gunma, Japan

Received 28 November 2007; revised 18 April 2008; accepted 28 April 2008; online publish-ahead-of-print 19 May 2008.

* Corresponding author. Tel: +81 27 220 8145, Fax: +81 27 220 8158, Email: s-kasama{at}bay.wind.ne.jp

Atrial natriuretic peptide (ANP) is a member of the natriuretic peptide family that exerts various biological effects via acting on the receptor-guanylyl cyclase system, increasing the content of intracellular cyclic guanosine monophosphate (cGMP). ANP was first identified as a diuretic/natriuretic and vasodilating hormone, but subsequent studies revealed that ANP has a very important function in the inhibition of the renin–angiotensin–aldosterone system (RAAS), endothelin synthesis, and sympathetic nerve activity. Evidence is also accumulating from recent work that ANP exerts its cardioprotective functions not only as a circulating hormone but also as a local autocrine and/or paracrine factor. ANP inhibits apoptosis and hypertrophy of cardiac myocytes, and inhibits proliferation and fibrosis of cardiac fibroblasts. Reperfusion of the ischaemic myocardium by percutaneous coronary intervention (PCI) reduces the infarct size and improves left ventricular (LV) function in patients with acute myocardial infarction (AMI). However, the benefits of PCI in AMI are limited by reperfusion injury. Animal studies have shown that ANP inhibits ischaemia/reperfusion injury, and reduces infarct size. We and others have recently shown that the intravenous administration of ANP inhibits RAAS, sympathetic nerve activity and reperfusion injury, prevents LV remodelling, and improves LV function in patients with AMI. ANP has a variety of cardioprotective effects and is considered to be a very promising adjunct drug for the reperfusion therapy in patients with AMI.

Key Words: Atrial natriuretic peptide • Myocardial infarction • Remodelling


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