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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Effects of Intravenous Atrial Natriuretic Peptide on Cardiac Sympathetic Nerve Activity and Left Ventricular Remodeling in Patients With First Anterior Acute Myocardial Infarction

Shu Kasama, MD^_*,_*, Takuji Toyama, MD^_*, Takashi Hatori, MD^_*, Hiroyuki Sumino, MD^_*, Hisao Kumakura, MD, Yoshiaki Takayama, MD, Shuichi Ichikawa, MD, Tadashi Suzuki, MD^_* and Masahiko Kurabayashi, MD^_*

^_* Department of Cardiovascular Medicine, Gunma University School of Medicine, Maebashi, Japan
Department of Internal Medicine, Cardiovascular Hospital of Central Japan, Gunma, Japan

Manuscript received April 24, 2006; revised manuscript received August 22, 2006, accepted September 18, 2006.

^_* Reprint requests and correspondence: Dr. Shu Kasama, Department of Cardiovascular Medicine, Gunma University School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan. (Email: s-kasama{at}bay.wind.ne.jp).

OBJECTIVES: We sought to evaluate the effects of atrial natriuretic peptide (ANP) on cardiac sympathetic nerve activity (CSNA) and left ventricular (LV) remodeling in patients with first anterior acute myocardial infarction (AMI) after primary coronary angioplasty.

BACKGROUND: The activation of the renin-angiotensin-aldosterone system (RAAS) prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide, a circulating hormone of cardiac origin, has vasodilatory and diuretic properties, and can inhibit the RAAS.

METHODS: We studied 50 patients with first anterior AMI who were randomly assigned to receive ANP (group A) or isosorbide dinitrate (group B) before and after primary coronary angioplasty. The ANP or ISDN was continuously infused >48 h. The extent score (ES) was determined from ^99mTc-pyrophosphate scintigraphy to evaluate the area of initial myocardial damage 3 to 5 days after primary angioplasty. The LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF) were determined by left ventriculography 2 weeks later. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from ¹²³I-meta-iodobenzylguanidine scintigraphy after 3 weeks.

RESULTS: After primary angioplasty, age, gender, risk factors, peak serum creatine phosphokinase concentration, recanalization time, and ES were similar in the 2 groups. However, in group A (n = 25), the TDS was significantly lower (34 ± 8 vs. 41 ± 8; p < 0.05), the H/M ratio was significantly higher (1.96 ± 0.18 vs. 1.74 ± 0.23; p < 0.05), and the WR was significantly lower (35 ± 8% vs. 44 ± 12%; p < 0.005) than in group B (n = 25). Moreover, the LVEDV and LVEF in group A were better than in group B (LVEDV: 85.5 ± 28.5 ml vs. 106.3 ± 39.4 ml [p < 0.05]; LVEF: 47.9 ± 10.2% vs. 41.5 ± 11.8% [p < 0.05]).

CONCLUSIONS: Intravenous ANP improves CSNA and prevents LV remodeling in patients with first anterior AMI.

Abbreviations and Acronyms   123I-MIBG = 123I-meta-iodobenzylguanidine   99mTc-PYP = 99mTc-pyrophosphate   AMI = acute myocardial infarction   ANP = atrial natriuretic peptide   ES = extent score   H/M = heart/mediastinum count   ISDN = isosorbide dinitrate   LV = left ventricular   LVEDP = left ventricular end-diastolic pressure   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   TDS = total defect score   WR = washout rate

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