| Research Abstract |
Circulating atrial natriuretic peptide (ANP) consists predominantly of alpha-form in normal subjects. Plasma ANP levels are elevated in patients with heart failure, which increase in relation to its seventy. However, circulating forms of ANP in patients with heart failure remain unknown. To elucidate clinical significance of ANP in heart failure, we have analyzed the molecular forms of plasma ANP in patients with conjestive heart failure by gel filtration and reverse-phase HPLC. As the seventy of heart failure progressed, the proportion of beta-form to the total ANP in plasma increased, and gamma-form also appeared. Circulating beta-form conversely decreased after successful treatment for heart failure. During cardiac surgery with extracorporeal circulation, plasma ANP levels did not significantly decrease after total aortic cross claming (TACC), remarkably increased after the release of TACC, where alpha-form predominated without distinct beta- or gamma-form. In patients with chronic renal failure, the predominant circulating ANP was alpha-form, although beta-form was also present in some cases. After hemodialysis, plasma ANP levels, mostly alpha-form, decreased these rats suggest that 1) the enhanced biosynthetic activity of ANP in the faility heart is associated with the increased processing from gamma- to alpha- and beta-form, 2) the processing of ANP secreted after the release of ATCC due to immediate rise in atrial pressure appears to be essentially similar to that of normal subjects, 3) the appearance of circulating beta-form in some renal failure patients may be due to delayed metabolism, increased body fluid and or metabolic change of myocardium, although its pathophysislogical function remains undetermined. From our results it appears that circulating beta-ANP should be a useful marker as a noninvasive parameter for assessment of heart failure as well as its therapeutic outcome.
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