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The vasopressor system in patients with heart failure due to idiopathic dilated cardiomyopathy-influence of the clinical stage of disease and of chronic drug treatment

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Summary

Alterations in the vasopressor system found in cardiac failure are part of compensatory measures that may modify pharmacologic-therapeutic response. Therefore, in 64 patients with dilated cardiomyopathy, we investigated its enhanced activity in different clinical stages of the disease as compared to normal controls. Patients in NYHA class II (n=20) demonstrated increased activity of the sympathico-adrenal, reninangiotensin-aldosterone, vasopressin, and atrial natriueretic factor systems, while maximum values were found in patients of NYHA class IV (n=24). In these patients, noradrenaline was enhanced by a factor of 7, adrenaline by a factor of 2, plasma-renin-activity by a factor of 7, angiotensin II by a factor of 2.5, aldosterone by a factor of 5, vasopressin by a factor of 1.5, and ANF by a factor of 4 as compared to normal controls

Clinical NYHA classes correlated to a certain degree with the various plasma hormones. Patients treated with an aldosterone inhibitor in addition to digitalis and diuretics revealed significantly higher values for aldosterone, vasopressin, and angiotensin II as compared to those who received digitalis and diuretics alone. The addition of ACE-inhibitor therapy resulted in a decrease of angiotensin II, aldosterone, and vasopressin. Plasma catecholamines and ANF, however, did not change under the influence of cardiac medication.

Diuretic treatment in NYHA class II patients reduced plasma volumes (p<0.01). Plasma volume in NYHA class IV patients only was found to be higher than in normal controls.

Thus, analysis of the neurohumoral system can aid both in the identification of the clinical degree of dilated cardiomyopathy and in its optimal therapy.

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References

  1. Abboud FM, Schmidt PG. Circulatory adjustments to heart failure. In: Fishman AP (ed).Heart Failure. New York: McGraw-Hill, 1978:249.

    Google Scholar 

  2. Ackermann U, Rudolph JR. Control of right atrial pressure at constant cardiac output suppresses volume natriuresis in anesthetized rats.Can J Physiol Pharmacol 1984;62:798.

    PubMed  Google Scholar 

  3. Bates ER, Shenker Y, Grekin RJ. The relationship between plasma levels of immunoreactive atrial natriuretic factor hormone and hemodynamic function in man.Circulation 1986;73:1155.

    PubMed  Google Scholar 

  4. Bates ER, Shenker Y, Grekin RJ. Plasma atrial natriuretic factor levels are markedly elevated in humans with biventricular dysfunction.Circulation 1985;72 (Suppl 3):411.

    Google Scholar 

  5. Belcher EH, Berlin NI, Eernisse JG, et al. Standard techniques for the measurement of red-cell and plasma volume. A report by the International Committee for Standardization in Hematology (ICSH): Panel on Diagnostic Applications of Radioisotopes in Haematology.Br J Haemat 1973;25:814.

    Google Scholar 

  6. Brown JJ, Davies DL, Johnson VW, Lever AF, Robertson JIS. Renin relationships in congestive cardiac failure, treated and untreated.Am Heart J 1970;80:329.

    PubMed  Google Scholar 

  7. Burnett JC, Kao PC, Hu DC, et al. Atrial natriuretic peptide elevation in congestive heart failure in the human.Science 1986;231:1145.

    PubMed  Google Scholar 

  8. Chidsey CA, Braunwald E. Sympathetic activity and neurotransmitter depletion in congestive heart failure.Pharmacol Rec 1966;18:865.

    Google Scholar 

  9. Chidsey CA, Braunwald E, Morrow AG. Catecholamine excretion and cardiac stores of norepinephrine in congestive heart failure.Am J Med 1965;39:442.

    PubMed  Google Scholar 

  10. Cody JR, Atlas SA, Laragh HJ, et al. Role of vasoconstrictor mechanism in the control of left ventricular performance of the normal and damaged heart.Am J Cardiol 1979;44:1019.

    PubMed  Google Scholar 

  11. Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to diagnosis in patients with chronic heart failure.N Engl J Med 1984;311:819–822.

    PubMed  Google Scholar 

  12. Currie MG, Geller DM, Cole BR, et al. Bioactive cardiac substances: Potent vasorelaxant activity in mammalian atria.Science 1983;221:71.

    PubMed  Google Scholar 

  13. Curtis C, Cohn JN, Vrobel, T, Franciosa JA. Role of the renin-angiotensin system in the systemic vasoconstriction of chronic congestive heart failure.Circulation 1978;58:763.

    PubMed  Google Scholar 

  14. DeBold AJ, Borenstein HB, Veress AT, et al. A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats.Life Sci 1981;28:89.

    PubMed  Google Scholar 

  15. Dietz R, Schömig A, Strasser R, Kübler W. Impaired inactivation of noradrenaline (NA) — a mechanism for stimulated sympathetic activity in heart failure.Circulation 1981;64 (Suppl II).

  16. Dzau VJ, Colucci WS, Hollenberg NK, Williams GH. Relation of the renin-angiotensin-aldosterone system to clinical state in congestive heart failure.Circulation 1981;63:645.

    PubMed  Google Scholar 

  17. Fitzsimons JT. The role of the renin-angiotensin system in the regulation of extracellular fluid volume. In: Jörgensen CB, Skadhange E (eds).Osmotic and Volume Regulation. Munksgaard, Copenhagen: 1978:100.

    Google Scholar 

  18. Francis GS, Goldsmith SR, Ziesche SM, Cohn JN. Response of plasma norepinephrine and epinephrine to dynamic exercise in patients with congestive heart failure.Am J Cardiol 1982;49:1152.

    PubMed  Google Scholar 

  19. Garcia R, Cantin M, Thibault G, et al. Relationship of specific granules to the natriuretic and diuretic activity of rat atria.Experentia 1982;38:1071.

    Google Scholar 

  20. Gavras H, Faxon DP, Berkoben J, Bruner HR, Ryan TJ. Angiotensin converting enzyme inhibition in patients with congestive heart failure.Circulation 1978;58:770.

    PubMed  Google Scholar 

  21. Haber E. The role of renin in normal and pathological cardiovascular homeostasis.Circulation 1976;54:849.

    PubMed  Google Scholar 

  22. Hosain P, Hosain F, Igbal QM, et al. Measurement of plasma volume using99Tcm and113Inm labelled proteins.Br J Radiol 1969;42:627.

    PubMed  Google Scholar 

  23. Kopin IJ. Plasma levels of norepinephrine.Ann Intern Med 1978;88:671.

    PubMed  Google Scholar 

  24. Kringe KP, Greb H, Bayha G, Kranich S, Mitrovic V. HPLC-routineanalytik von freiem noradrenalin und adrenalin. Ihre bestimmung in plasma, urin und gewebe mittels hochleistungsflüssigkeits-chromatographie und elektrochemischer detektion.LABO-Fachzeitschrift für Labortechnik 1986;17:7.

    Google Scholar 

  25. Lehmann M, Keul J, Löllgen J, Just H. Plasmakatecholamine und hämodynamik bei gestörter linksventrikulärer funktion in ruhe und während belastung.Z Kardiol 1981;70:238.

    PubMed  Google Scholar 

  26. Levine BT, Francis GS, Goldsmith SR, Simon AB, Cohn JN. Activity of the sympathetic nervous system and reninangiotensin system assessed by plasma hormone levels and their relation to hemodynamic abnormalities in congestive heart failure.Am J Cardiol 1982;49:1659.

    PubMed  Google Scholar 

  27. Maack T, Marion DN, Camargo MJF, et al. Effects of auriculin (atrial natriuretic factor) on blood pressure, renal function, and the renin-aldosterone system in dogs.Am J Med 1984;77:1069.

    PubMed  Google Scholar 

  28. Mäurer W, Ablasser A, Tschada R, Saggau W, Kübler W. Myocardial catecholamine metabolism in patients with chronic aortic regurgitation.Circulation 1981;64 (SupplII):259.

    Google Scholar 

  29. Malliani A, Lombardi F, Pagani M. Functions of afferent in cardiovascular sympathetic nerves.J Auton Nerv System 1981;3:231.

    Google Scholar 

  30. Manthey J, Dietz R, Hackenthal E, Ke YN, Leinberger H, Schömig A, Schwarz F, Kübler W. Effect of vasodilator therapy on sympathetic activity in patients with impaired left ventricular function. In: Delius W, Gerlach E, Grobecker H, Kübler W (eds).Catecholamines and the heart. Berlin, Heidelberg, New York: Springer-Verlag, 1981;388.

    Google Scholar 

  31. Manthey J, Dietz R, Hackenthal E, Röhrig N, Schmidt-Gayk H, Schömig A, Schwarz F, Kübler W. Linksventrikuläre funktion und aktivität vasopressorischer systeme bei patienten mit chronischer herzinsuffizienz.Z Kardiol 1984;73:279.

    PubMed  Google Scholar 

  32. Mason DT, Zelis R, Longhurst J, Lee G. Cardiocirculatory responses to muscular exercise in congestive heart failure.Prog Cardiovasc Dis 1977;19:475.

    PubMed  Google Scholar 

  33. Molina CR, Leitman D, Fowler MD, et al. Atrial natriuretic factor release and renal clearance in heart failure.Circulation 1986;74 (Suppl 2):438.

    Google Scholar 

  34. Ogawa K, Ito T, Hashimoto H, et al. Plasma atrial natriuretic factor in congestive heart failure.Lancet 1986;1:106.

    PubMed  Google Scholar 

  35. Palm D, Grobecker, H. Quantitative parameter der sympatho-nervalen und sympatho-adrenalen aktivatät beim menschen.Arzneim Forsch Drug Res 1977;27:708.

    Google Scholar 

  36. Raine AEG, Erne P, Burgisser E, et al. Atrial natriuretic peptide and atrial pressure in patients with congestive heart failure.N Engl J Med 1986;315:533.

    PubMed  Google Scholar 

  37. Richards AM, Ikram H, Yandle TG, et al. Renal, haemodynamic, and hormonal effects of human alpha atrial natriuretic peptide in healthy volunteers.Lancet 1985;1:545.

    PubMed  Google Scholar 

  38. Riegger GAJ, Liebau G, Kochsiek K. Antidiuretic hormone in congestive heart failure.Am J Med 1982;72:49.

    PubMed  Google Scholar 

  39. Riegger GAJ, Kromer EP, Kochsiek K. Human atrial natriuretic peptide: Plasma levels, hemodynamic hormonal and renal effects in patients with severe congestive heart failure.J Cardiovasc Pharmacol 1986;8:1107.

    PubMed  Google Scholar 

  40. Robertson D, Johnson GA, Robertson RM, Nies AS, Shand DG, Oates JA. Comparative assessment of stimuli that release neuronal and adrenomedullary catecholamines in man.Circulation 1979;59:637.

    PubMed  Google Scholar 

  41. Shenker Y, Sider RS, Ostafin EA, et al. Plasma levels of immunoreactive atrial natriuretic factor in healthy subjects and in patients with edema.J Clin Invest 1985;76:1684.

    PubMed  Google Scholar 

  42. Spearman, C. (1) The proof and measurement of association between two things.Am J Psychol 1904;15:72. (2) The method “of right and wrong cases” (“constant stimuli”) without Gauss' formulae.Br J Psychol 1908;2:227.

    Google Scholar 

  43. Szatalowics VL, Arnold PE, Chaimovitz C, Bichet D, Berl T, Schrier RW. Radioimmunoassay of plasma arginine vasopressin in hyponatremic patients with congestive heart failure.N Engl J Med 1981;305:263.

    PubMed  Google Scholar 

  44. Thomas JA, Marks BH. Plasma norepinephrine in congestive heart failure.Am J Cardiol 1978;41:233.

    PubMed  Google Scholar 

  45. Tikkanen I, Fyhrquist F, Metsarinne K, et al. Plasma atrial natriuretic peptide in cardiac disease and during infusion in healthy volunteers.Lancet 1985;2:66.

    PubMed  Google Scholar 

  46. Watkins L, Burton JA, Haber E, Cant JR, Smith FW, Barger AC. The renin-angiotensin-aldosterone system in congestive failure in conscious dogs.J Clin Invest 1976;57:1606.

    PubMed  Google Scholar 

  47. Wood EJ. The mechanism of the increased venous pressure with exercise in congestive heart failure.J Clin Invest 1952;41:2020.

    Google Scholar 

  48. Yang SSL, Nickoloff EL, McIntyre PA, Maddrey WC, Mikesell HH, Scheffel U, Kasecamp W, MacAllister NP. Tc-99m human serum albumin: A suitable agent for plasma volume measurements in man.Clin Sci 1978;19:804.

    Google Scholar 

  49. Zelis R, Mason DT. Compensatory mechanisms in congestive heart failure—the role of the peripheral resistance vessels.N Engl J Med 1970;282:962.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Kerckhoff-Klinik, Benekestrasse 2-8, 6350, Bad Nauheim, FRG

    V. Mitrovic MD

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  2. J. Thormann
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  3. P. Kornecki
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  4. M. Volz
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Mitrovic, V., Thormann, J., Kornecki, P. et al. The vasopressor system in patients with heart failure due to idiopathic dilated cardiomyopathy-influence of the clinical stage of disease and of chronic drug treatment. Cardiovasc Drug Ther 3, 771–778 (1989). https://doi.org/10.1007/BF01857630

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