Naslov
Role of atrial stretch in the acute release of atrial natriuretic peptide

Autori
Degoricija, Vesna ; Zjačić-Rotkvić, Vanja ; Šefer, Siniša

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Acta Clinica Croatica 2001 ; 40 (suppl 1) / Mihativ, Šime ; Planinc, Danijel - Zagreb : Hrvatsko kardiološko društvo, 2001, 87-88

Skup
9th Alpe Adria Cardiology Meeting

Mjesto i datum
Cavtat, Hrvatska, 06.06.2001. - 09.06.2001

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
liver cirrhosis; therapy; ascites; therapy; paracentesis; volume replacement; atrial strech; atrial natriuretic peptide

Sažetak
Introduction. Atrial natriuretic peptide (ANP), a hormon secreted by the cardiac atria in response to changes in pressure as measured by strech receptors in the atria wall, has a spectrum of renal, hemodynamic and endocrine actions, all of which serve to reduce the elevated blood volume. In patients (pts) with cirrhosis of the liver plasme levels of ANP are attributable to several factors: high blood volume, effective hypovolemia, hyperdynamic circulation, posture, intraabdominal and intrathoracic pressure, sodium intake and drug administration. In Child-Pugh C cirrhosis of the liver with tense ascites plasma levels of ANP are recorded as low, normal and high. Aim. To assess postparacentesis hemodynamic and neurohumoral changes and the influence of the paracentesis, bed rest 24 hours before and after the paracentesis and volume replacement on the acute release of ANP in patients with refractory tense ascites in Child-Pugh C cirrhosis. Methods. 50 pts with Child-Pugh C liver cirrhosis and tense ascites, without toxic cardiomyopathy, were randomly allocated into 5 groups. 30 pts (groups 1, 2, 3) were treated with paracentesis (6 L) associated with plasma volume expansion (200 mL 20% human albumin, 600 mL fresh frosen plasma, 900 mL solution of synthetic gelatin, which were doses with comparable oncotic power) and bed rest 24 hours before and after the procedure, vs. 10 pts (group 4) treated with paracentesis of 6 L of ascites without volume replacement and no bed rest and 10 pts (group 5) treated with furosemid 40 mg intravenously every day and no bed rest. Mean arterial pressure, pulse rate, plasma renin activity, plasma aldosteron concentration, plasma atrial natriuretic peptide levels, urine flow rate, creatinine clearance and osmolality clearance were measured before, 6 hours after start of the trial and on the 2nd, 3rd, and 6th day. Results. Paracentesis of 6 L of ascites without plasma volume expansion and no bed rest 24 hours before and after the procedure is associated with statistically significant hypotension (p=0, 000), tachycardia (p=0, 000), increase in plasma renin activity (p=0, 024), increase of plasma aldosteron concentration (p=0, 000), decrease in plasma atrial natriuretic peptide levels (NS) and renal impairment measured with creatinine clearance (p=0, 046). There was no statistically significant difference in basic plasma ANP levels (pg/mL) between groups 1, 2, 3 (38, 87+/-67, 84), group 4 (18, 60+/-18, 86) and group 5 (22, 50+/-18, 42). 6 hours after the procedure there were marked (NS) increases in plasma ANP levels in group 1 (50, 40+/-27, 33), group 2 (54, 60+/-88, 40) and group 3 (72, 90+/-118, 82) in contrast to group 4 (23, 90+/-20, 03) and group 5 (19, 50+/-18, 38). Increase in plasma ANP levels was proportional to amount of volume replacement. On the 2nd day ANP levels were: groups 1, 2, 3 (42, 20+/-88, 03), group 4 (12, 80+/-8, 57) and group 5 (18, 70+/-12, 76). On the 3rd day ANP levels had further decreases for groups 1, 2, 3 (35, 67+/-66, 42), but they were never as low as in group 4 (16, 00+/-16, 65) and group 5 (16, 90+/-11, 01) On the 6th day plasma ANP levels were similar to basic levels for all groups: groups 1, 2, 3 (35, 30+/-61, 71), group 4 (15, 20+/-11, 60), and group 5 (16, 90+/-17, 89). Conclusion. The results of our investigation indicate that cardiac release of ANP in response to volume expansion is not impaired in patients with Child-Pugh C cirrhosis of the liver and tense ascites. The main mechanism stimulating the acute release of ANP is atrial streching, induced with volume replacement and is proportional to its amount.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA