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      Serial Changes in Atrial Natriuretic Peptide and Endothelin-1 Concentrations

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          Aim: The study was designed to assess temporal changes in atrial natriuretic peptide (ANP) and endothelin-1 (ET) concentrations in patients hospitalized for acute myocardial infarction (AMI) and their relationships to cardiac performance determined by radionuclide ventriculography. Patients and Methods: 20 patients with first AMI were studied. Blood samples were drawn within the first 4–18 h, after 18–24 h, and on days 2, 3 and 6. Plasma concentrations of ANP and ET were measured in blood samples taken simultaneously. Radionuclide ventriculography was performed on the day of discharge to determine left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume index, end-systolic volume index and left-ventricular stroke volume index. Results: Median concentrations of ET decreased from 2.15 pmol/l on admission to 1.45 pmol/l at discharge (32%, p < 0.001). Median ANP rose from 29 to 79 pg/ml (172%, p < 0.001). The increment in ANP and the decrease in ET concentrations from admission to discharge was inversely correlated (r = –0.81, p < 0.005). ANP was inversely correlated to LVEF (r = –0.82, p < 0.001) and to the end-systolic volume index at discharge (r = –0.73, p < 0.003). Conclusion: Dynamic and inverse fluctuations in ET and ANP occur within the 1st week of AMI. The magnitude of endocrine activation in the ANP-ET system seems to reflect an impairment in the left-ventricular systolic performance.

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          A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results.

          The beta-Blocker Heart Attack Trial (BHAT) was a National Heart, Lung, and Blood Institute-sponsored, multicenter, randomized, double-blind, and placebo-controlled trial designed to test whether the regular administration of propranolol hydrochloride to men and women who had experienced at least one myocardial infarction would result in a significant reduction in total mortality during a two- to four-year period. During a 27-month interval, 3,837 persons between the ages of 30 and 69 years were randomized to either propranolol (1,916 persons) or placebo (1,912 persons), five to 21 days after the infarction. Depending on serum drug levels, the prescribed maintenance dose of propranolol hydrochloride was either 180 or 240 mg/day. The trial was stopped nine months ahead of schedule. Total mortality during the average 24-month follow-up period was 7.2% in the propranolol group and 9.8% in the placebo group. Arteriosclerotic heart disease (ASHD) mortality was 6.2% in the propranolol group and 8.5% in the placebo group. Sudden cardiac death, a subset of ASHD mortality, was 3.3% among the propranolol patients and 4.6% among the placebo patients. Serious side effects were uncommon. Hypotension, gastrointestinal problems, tiredness, bronchospasm, and cold hands and feet occurred more frequently in the propranolol group. Based on the BHAT results, the use of propranolol in patients with no contraindications to beta-blockade who have had a recent myocardial infarction is recommended for at least three years.
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            Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure

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              Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction


                Author and article information

                S. Karger AG
                March 1998
                16 March 1998
                : 89
                : 3
                : 210-215
                Departments of a Clinical Physiology and Nuclear Medicine, b Internal Medicine C, Glostrup Hospital, and Departments of c Clinical Physiology and Nuclear Medicine, Frederiksberg Hospital and Rigshospitalet, University of Copenhagen, Denmark
                6789 Cardiology 1998;89:210–215
                © 1998 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 2, References: 32, Pages: 6
                Coronary Care


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