Plasma concentrations of atrial natriuretic peptide during physical exercise in patients with congestive heart failure

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Abstract
Plasma concentrations of atrial natriuretic peptide (ANP) were measured in 25 patients with organic heart disease during physical exercise (baseline and maximum workload) in order to investigate if the responsiveness of stimulated release of ANP is still preserved in patients with heart failure and chronically elevated cardiac filling pressures. Since plasma concentrations of ANP are known to be positively correlated with mean right atrial pressures (RAP), the patients were divided into two groups according to their resting RAP: group I: those with normal RAP (≤ 5 mmHg; n=11); group II: those with elevated RAP (>5 mmHg; n=14). Under baseline conditions RAP (3.2±0.4 mmHg vs. 8.8±0.7 mmHg; p<0.01), pulmonary artery diastolic pressure (PADP; 9.5±0.9 mmHg vs. 17.9±1.8 pg/ml; p.<0.01), and plasma ANP levels (128±19 pg/ml vs. 204±60 pg/ml; p<0.06) were significantly lower in group I than in group II. Both at rest and during maximum workload, plasma ANP concentrations were closely related to RAP, PADP, and mean pulmonary artery pressures in both groups. During exercise in all patients, RAP and PADP significantly increased, as well as plasma ANP concentrations. Similar increments in plasma ANP concentrations were accompanied by greater changes in RAP in group II than in group I. However, identical changes in PADP lead to identical increments in plasma ANP concentrations in both groups. In conclusion, the increments of plasma ANP concentrations during physical exercise were independent of the resting values of PADP, RAP, and plasma ANP concentrations. During exercise the increments in plasma ANP concentrations for identical changes of PADP were not significantly influenced by the resting conditions; only in patients with elevated RAP at rest did increments in RAP during exercise induce a slightly reduced ANP release compared with patients who had normal right ventricular filling pressures. These data indicate that the responsiveness of ANP release during physical exercise is only slightly impaired in patients with heart failure and chronically elevated cardiac filling pressures.