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J Am Coll Cardiol, 2001; 37:1820-1826
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: MYOCARDIAL INFARCTION

Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction

Masaru Hayashi, MDa, Takayoshi Tsutamoto, MDa, Atsuyuki Wada, MDa, Keiko Maeda, MDa, Naoko Mabuchi, MDa, Takashi Tsutsui, MDa, Hajime Horie, MDa, Masato Ohnishi, MDa and Masahiko Kinoshita, MDa

a First Department of Internal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan

Manuscript received November 1, 2000; revised manuscript received January 30, 2001, accepted February 15, 2001.

Reprint requests and correspondence: Dr. Takayoshi Tsutamoto, First Department of Internal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
tutamoto{at}belle.shiga-med.ac.jp

OBJECTIVES

The study evaluates the effect of atrial natriuretic peptide (ANP) compared with nitroglycerin (GTN) on left ventricular (LV) remodeling after first anterior acute myocardial infarction (AMI).

BACKGROUND

Compared with GTN, ANP suppresses the renin-angiotensin-aldosterone system and endothelin-1 (ET-1), which stimulate LV remodeling.

METHODS

Sixty patients with a first anterior AMI were randomly divided into the ANP (n = 30) or GTN (n = 30) groups after direct percutaneous transluminal coronary angioplasty. We evaluated LV ejection fraction (LVEF), end-diastolic volume index (LVEDVI) and end-systolic volume index (LVESVI) at the acute phase and after one month. We also measured neurohumoral factors during study drug infusion.

RESULTS

There was no difference in the baseline characteristics or LVEF (46.9 ± 1.0 vs. 46.8 ± 1.3%) between the two groups. Although there was no difference in hemodynamics during the infusion periods, the LVEF was significantly improved after one month compared with the baseline value in both groups, but it was improved more in the ANP group than in the GTN group (54.6 ± 1.1%, 50.8 ± 1.3%, p < 0.05). Left ventricular enlargement was prevented in the ANP group (LVEDVI, 85.8 ± 3.1 ml/m2 to 87.3 ± 2.7 ml/m2; p = ns, LVESVI, 45.6 ± 1.8 ml/m2 to 41.0 ± 2.1 ml/m2, p < 0.05) but not in the GTN group (LVEDVI, 86.2 ± 4.1 to 100.2 ± 3.7, p < 0.01; LVESVI, 46.3 ± 2.8 ml/m2 to 51.1 ± 3.0 ml/m2, p = ns). During the infusion, ANP suppressed plasma levels of aldosterone, angiotensin II and ET-1 compared with GTN.

CONCLUSIONS

These findings indicate that in patients with a first anterior AMI, an ANP infusion can prevent LV remodeling better than can GTN, and effectively suppresses aldosterone, angiotensin II and ET-1.

Abbreviations and Acronyms
  ALD = aldosterone
  AMI = acute myocardial infarction
  Ang II = angiotensin II
  ANP = atrial natriuretic peptide
  BNP = brain natriuretic peptide
  cGMP = cyclic guanosine monophosphate
  CK = creatine phosphokinase
  ET-1 = endothelin-1
  GTN = nitroglycerin
  LV = left ventricular
  LVEDVI = left ventricular end-diastolic volume index
  LVEF = left ventricular ejection fraction
  TIMI = Thrombolysis In Myocardial Infarction




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