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1 J Cardiol 2001 ; 38: Clinical Significance of Plasma Atrial and Brain Natriuretic Peptide Levels During Hemodialysis in Hemodialysis Patients With Old Myocardial Infarction Shuichiro Masaki Kouichi Takeaki Tsutomu Shigeo UETAKE, MD TAKAHASHI, MD TAMANO, MD HONDA, MD KOBAYASHI, MD HORINAKA, MD Abstract Objectives. The plasma levels of atrial natriuretic peptide ANP and brain natriuretic peptide BNP are useful to evaluate left ventricular function in patients with old myocardial infarction OMI. This echocardiographic study examined the clinical importance of the measurement of ANP and BNP in patients with OMI undergoing hemodialysis. Methods. ANP and BNP levels were measured before and after hemodialysis in 36 patients with OMI and 42 patients without ischemic heart disease as controls control group. Echocardiography was performed after hemodialysis. The patients with OMI were classified into two groups according to left ventricular percentage fractional shortening % FS : Normal OMI-N group with %FS 30% n 19 and low OMI-L group with %FS 30% n 17. Results. The ANP, BNP levels and BNP/ANP ratio before and after hemodialysis were significantly higher in the OMI-L group than in the other groups. BNP level was significantly inversely correlated with %FS r 0.60, p 0.05 and correlated with E wave and E/A, in mitral inflow only in the OMI-L group. The decrease in BNP level during hemodialysis was significantly greater in the OMI-L group than in the other groups, but not in ANP level. Conclusions. These findings suggest that ANP and BNP levels are increased in patients with left ventricular dysfunction undergoing hemodialysis compared to those with normal left ventricular function. ANP level is convenient for decision of suitable dry weight. In contrast, BNP level that correlated inversely with impairment of left ventricular function is a more sensitive index of left ventricular function than ANP in patients with OMI undergoing hemodialysis. J Cardiol 2001 ; 38 2 : Key Words Natriuretic peptides atrial, brain Renal function hemodialysis Myocardial infarction, pathophysiology old Echocardiography, transthoracic 3 Na 1 3 Na atrial natriuretic peptide: ANP Na brain natriuretic peptide : BNP BNP 4 7 : Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, Tochigi Address for correspondence : UETAKE S, MD, Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu-machi, Shimotsuga-gun, Tochigi Manuscript received February 7, 2001 ; revised April 17, 2001 ; accepted April 18,
2 62 8,9 ANP BNP ANP BNP ANP 16,17 BNP old myocardial infarction: OMI ANP BNP 1 ANP BNP OMI OMI Q Q Q 2 ANP ANP BNP BNP SSA-380A SSH-160A M MHz 2.5MHz M LSR-100A 50 mm/sec American Society of Echocardiography 18 / 100 / E A OMI 30% OMI-N 19 30% OMI-L ANP BNP 3 t 3 2 p 0.05 E A 1 Table 1 body mass index OMI-N OMI-L OMI-N OMI-L OMI-L 1 OMI-N 2 2 Table 2 OMI-L
3 Na 63 Table 1 Clinical characteristics of the patients Control group n 42 OMI-N group n 19 OMI-L group n 17 Age yr Sex male/female 21/21 15/4 13/4 Body mass index after HD g/m Etiology of chronic renal failure DM/non DM 13/29 8/11 10/7 Duration of HD month Systolic blood pressure mmhg Before HD After HD Decrease in body weight during HD % Myocardial infarction location Anterior 10 3 Inferior 8 6 Posterior 1 1 Anterior and inferior 0 7 Continuous values are mean SD. p 0.05, p 0.01 vs control group, p 0.05 vs OMI-L group. OMI old myocardial infarction ; OMI-N group normal cardiac function group percentage fractional shortening 30% ; OMI-L group low cardiac function group percentage fractional shortening 30% ; HD hemodialysis ; DM diabetes mellitus. Table 2 Echocardiographic data after hemodialysis Control group n 42 OMI-N group n 19 OMI-L group n 17 Heart rate beats/min AOD mm LAD mm IVSth mm LVPWth mm LVDd mm LVDs mm %FS % Pulsed-wave Doppler index E m/sec A m/sec E/A Inferior vena cava Inspiratory phase mm Expiratory phase mm Collapsibility index Continuous values are mean SD. p 0.05, p 0.01, p vs control group, p 0.05, p 0.005, p vs OMI-N group. AOD aortic dimension ; LAD left atrial dimension ; IVSth interventricular septal thickness ; LVPWth left ventricular posterior wall thickness ; LVDd s left ventricular end-distolic systolic diameter ; %FS percentage fractional shortening. Other abbreviation and explanation of the groups as in Table 1.
4 64 Fig. 1 Changes in plasma atrial natriuretic peptide levels during hemodialysis Values are mean SD. p 0.005, p 0.001, p vs value before HD in all groups, p vs control group before HD, p 0.05 vs OMI-N group before HD, p vs control group after HD, p 0.01 vs OMI-N group after HD. ANP atrial natriuretic peptide. Other abbreviations and explanation of the groups as in Table 1. Fig. 2 Changes of plasma brain natriuretic peptide levels during hemodialysis Values are mean SD. p 0.005, p vs value before HD in all groups, p vs control group before HD, p vs OMI-N group before HD, p vs control group after HD, p vs OMI-N group after HD. BNP brain natriuretic peptide. Other abbreviations and explanation of the groups as in Table 1. OMI-N 3 OMI-L OMI-L OMI- L OMI-N OMI-N OMI-L OMI-N OMI-N OMI-L 3 E E/A 3 A OMI-NOMI-L
5 Na 65 Fig. 3 Comparison between BNP/ANP before left and after hemodialysis right Values are mean SD. p vs control group, p 0.05 vs OMI-N group. Explanation of the groups and abbreviations as in Table 1, Figs. 1, 2. Fig. 4 Comparison of decrease in plasma ANP levels right and in plasma BNP levels left during hemodialysis Values are mean SD. p 0.05 vs control group. Explanation of the groups and abbreviations as in Table 1, Figs. 1, ANP BNP 3 ANP BNP OMI-L OMI-N OMI-N Figs. 1, 2 BNP/ANPOMI-L OMI-N OMI-N Fig. 3 ANP BNP 3 Figs. 1, 2 ANP 3 BNP OMI-L OMI-Np 0.10 Fig. 4ANP 3 BNP p ANP BNP OMI-LBNP BNP/ANP Figs. 5, 6 BNP OMI-L E E/A Fig. 7
6 66 Fig. 5 Correlation between plasma BNP levels and percentage fractional shortening before left and after right hemodialysis in the OMI-L group Explanation of OMI-L group and abbreviations as in Tables 1, 2, Fig. 2. Fig. 6 Correlation between BNP/ANP ratio and percentage fractional shortening before left and after right hemodialysis in the OMI-L group Explanation of OMI-L group and abbreviations as in Tables 1, 2, Figs. 1, 2. OMI-N ANP BNP E E/A ANP BNP ANP BNP BNP 1 BNP BNP ANP 1 ANP BNP ANP BNP BNP ANP 4 7 ANP BNP
7 Na 67 Fig. 7 Correlation between plasma BNP level and E wave or E/A ratio from the Doppler mitral flow velocity curves before and after hemodialysis in the OMI-L group Explanation of OMI-L group and abbreviations as in Table 1, Fig ,20 BNP Nitta 21 60% 60%BNP BNP ANP BNP BNP 22 BNP 10 BNP BNP BNP ANP BNP BNP ANP BNP E E/A E E/A BNPE E/A E/A BNP 26 BNP BNP BNP/ANP 14 BNP/ANP 2 BNP
8 68 ANP 1 ANP 16,17 1 ANP 3 1 ANP 3 ANP 1 BNP BNP ANP BNP 1 BNP Kohse 15 Nitta 21 BNP BNP ANP BNP 1 BNP ANP 1 Lang 13 BNP BNP Nitta BNP BNP OMI-L OMI-N BNP ANP BNP ANP BNP X ANP BNP ANP BNP ANP BNP peak-dp/dt ANP BNP ANP BNP 60% 30% 1ANP BNP
9 Na 69 2 ANP BNP BNP ANP 3 BNP 4 ANP : Na ANP Na BNP ANP BNP : 36 OMI 42 ANP BNP 30% OMI-N 19 30% OMI-L 17 2 : ANP BNP BNP/ANP OMI-L OMI-N OMI-NOMI-L BNP r 0.60 p 0.05 E r 0.74 p 0.05 E/A r 0.73 p 0.01 ANP 1 ANP % OMI-N % OMI-L % BNP OMI-L % % p 0.05 OMI-N % : ANP BNP BNP 1 ANP BNPANP BNP ANP BNP ANP BNP ANP J Cardiol 2001; 38 2 : Kangawa K, Matsuo H : Purification and complete amino acid sequence of -human atrial natriuretic polypeptide -hanp. Biochem Biophys Res Commun 1984 ; 118 : Sudoh T, Kangawa K, Minamino N, Matsuo H : A new natriuretic peptide in porcine brain. Nature 1988 ; 332 : Sudoh T, Minamino N, Kangawa K, Matsuo H : C-type natriuretic peptide CNP : A new member of natriuretic peptide family identified in porcine brain. Biochem Biophys Res Commun 1990; 168: Tsutamoto T, Bito K, Kinoshita M : Plasma atrial natriuretic polypeptide as an index of left ventricular end-diastolic pressure in patients with chronic left-sided heart failure. Am Heart J 1989; 117: Mukoyama M, Nakao K, Hosoda K, Suga S, Saito Y, Ogawa Y, Shirakami G, Jougasaki M, Obata K, Yasue H, Kambayashi Y, Inouye K, Imura H : Brain natriuretic peptide as a novel cardiac hormone in humans : Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 1991; 87 : Yoshimura M, Yasue H, Okumura K, Ogawa H, Jougasaki M, Mukoyama M, Nakao K, Imura H : Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 1993; 87 : Yasue H, Yoshimura M, Sumida H, Kikuta K, Kugiyama K, Jougasaki M, Ogawa H, Okumura K, Mukoyama M, Nakao K: Localization and mechanism of secretion of B-
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Hypertension 1996; 28 : Arad M, Elazar E, Shotan A, Klein R, Rabinowitz B : Brain and atrial natriuretic peptides in patients with ischemic heart disease with and without heart failure. Cardiology 1996; 87 : Talwar S, Squire IB, Downie PF, Davies JE, Ng LL : Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina. Heart 2000; 84 : Kikuta K, Yasue H, Yoshimura M, Morita E, Sumida H, Kato H, Kugiyama K, Ogawa H, Okumura K, Ogawa Y, Nakao K : Increased plasma levels of B-type natriuretic peptide in patients with unstable angina. Am Heart J 1996 ; 132: Yoshibayashi M, Kamiya T, Saito Y, Matsuo H: Increased plasma levels of brain natriuretic peptide in hypertrophic cardiomyopathy. N Engl J Med 1993 ; 329: Hasegawa K, Fujiwara H, Doyama K, Miyamae M,
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Yamagata Journal of Health Sciences, Vol. 8, 2005 Chikako SAITOU, Miharu NISHIWAKI This study has been undertaken to make clear the relationship of menstruation pattern to self-awareness, premenstrual
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12 61 1 2011 原著 1)2)5) 1) 1)2) 1)2)5) 1)3)5) 1)2) 1)2)5) 1)2) 1)2) 2) 2) 4) 1) 1) 2) 3) 4) 5) 2010 10 6 2010 12 6 A Comparative Study of the Effect and Discomfort Produced by Pharyngeal Anesthesia with
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1 1 ejection fraction EF 1 stroke volume SV left ventricular end-diastolic volume LVEDV SV LVEDV left ventricular end-systolic volume LVESV EF EF LVEDV LVESV 100 LVEDV M 2D M end-diastolic dimension: LVDd
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32 2008 pp. 93 106 1 Received October 30, 2008 The purpose of this study is to examine the effects of aerobics training class on weight loss for female students in HOKURIKU UNIVERSITY. Seventy four female
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