Abstract
Background: Atrial natriuretic peptide (ANP) is released from cardiac atrium secondary to increased atrial pressure. The plasma levels of ANP have been found to be related to short‐and long‐term prognosis after acute myocardial infarction (MI). The purpose of the present study was to investigate the plasma levels of ANP in three groups of patients with inferior wall acute MI classified according to ST‐segment depression in the precordial leads.
Methods: The study population consisted of 18 patients with inferior wall acute MI classified into three types: Type 1 = no precordial ST‐segment depression (7 patients), Type 2 = sum of ST‐segment depression in leads V1 to V3 equal to or more than the sum of ST‐segment depression in leads V4 to V6 (4 patients), and Type 3 = maximal precordial ST‐segment depression in leads V4 to V6 (7 patients).
Results: Radioimmunoassay showed that plasma ANP levels were significantly higher in patients with Type 3 acute inferior wall myocardial infarction compared with those with Types 1 and 2 (313.1 ± 233, 73.0 ± 27.5), and 84 ± 32.7 pg/ml, respectively, p = 0.018).
Conclusions: Plasma ANP levels are higher in patients with Type 3 acute inferior wall MI compared with patients with Types 1 and 2. These findings, together with earlier ones, may contribute to our understanding of the pathophysiology of the presence of ST‐segment depression in the precordial leads in inferior wall acute MI.
Keywords: inferior wall myocardial infarction, atrial natriuretic peptide, precordial ST‐segment depression
Full Text
The Full Text of this article is available as a PDF (525.7 KB).
References
- 1. Rodeheffer RJ, Tanaka I, Imada F, Hollister AS, Robertson D, Inagami T: Atrial pressure and secretion of atrial natriuretic factor into the human central circulation. J Am Coll Cardiol 1986; 8: 18–26 [DOI] [PubMed] [Google Scholar]
- 2. Dietz JR, Nazian SJ, Vesely DL: Release of ANF, pro‐ANF 1–98, and pro‐ANF 36–67 from isolated rat atria by atrial distension. Am J Physiol 1991; 260: H1774–H1778 [DOI] [PubMed] [Google Scholar]
- 3. Goetz KL: Physiology and pathophysiology of atrial peptides. Am J Physiol 1988; 254: E1–15 [DOI] [PubMed] [Google Scholar]
- 4. Bonow RO: New insights into the cardiac natriuretic peptides. Circulation 1996; 93: 1946–1950 [DOI] [PubMed] [Google Scholar]
- 5. Tomoda H: Atrial natriuretic peptide in acute myocardial infarction. Am J Cardiol 1988; 62: 1122–1123 [DOI] [PubMed] [Google Scholar]
- 6. Tan ACITL, Van Loenhout TT, Lamfers EJP, Hooghoudt TEH, Kloppenborg PWC, Benraad JJ: Atrial natriuretic peptide after myocardial infarction. Am Heart J 1989; 118: 490–494 [DOI] [PubMed] [Google Scholar]
- 7. Ngo L, Vesely DL, Bissett JK, Murphy ML, Dinh H, Seth R, Sallman AL, Rico DM, Winters CJ, Wyeth RP, Newton MT, Hester WL, Reck A: Acute and sustained release of atrial natriuretic factor with acute myocardial infarction. Am Heart J 1989; 118: 893–900 [DOI] [PubMed] [Google Scholar]
- 8. Korup E, Toft E, Rasmussen K: Plasma atrial natriuretic peptide is related to systolic but not diastolic myocardial function. Eur Heart J 1995; 16: 485–489 [DOI] [PubMed] [Google Scholar]
- 9. Richards AM, Cleland JGF, Tonolo C, McIntyre GD, Leckie BJ, Dargie HJ, Ball SG, Robertson JI: Plasma alpha natriuretic peptide in cardiac impairment. Br Med J 1986; 293: 409–412 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Mathisen P, Hall C, Simonsen S: Comparative study of atrial peptides ANF (1–98) and ANF (99–126) as diagnostic markers of atrial distension in patients with cardiac disease. Scand J Clin Lab Invest 1993; 53: 41–49 [DOI] [PubMed] [Google Scholar]
- 11. Hasdai D, Sclarovsky S, Solodky A, Sulkes J, Strasberg B, Bimbaum Y: Prognostic significance of maximal precordial ST segment depression in right (V1 to V3) versus left (V4 to V6) leads in patients with inferior wall acute myocardial infarction. Am J Cardiol 1994; 74: 1081–1084 [DOI] [PubMed] [Google Scholar]
- 12. Kingh JW, Ryan TJ: Right ventricular infarction. N Engl J Med 1994; 330: 1211–1217 [DOI] [PubMed] [Google Scholar]
- 13. Tan AC, Rosmalen FM, Hofman JA, Kloppenborg PW, Benraad TJ: Evaluation of a direct assay for atrial natriuretic peptide. Clin Chem Acta 1989; 179: 1–12 [DOI] [PubMed] [Google Scholar]
- 14. Hlaky MA, Califf RM, Lee KL, Pryor DB, Wagner GS, Rosati RA: Prognostic significance of precordial ST segment depression during inferior acute myocardial infarction. Am J Cardiol 1985; 55: 325–329 [DOI] [PubMed] [Google Scholar]
- 15. Bates ER, Clemmensen PM, Califf RM, Gorman LE, Aronso LG, George BS, Kereiakes DJ, Topol EJ: Precordial ST segment depression predicts a worse prognosis in inferior infarction despite reperfusion therapy. J Am Coll Cardiol 1990; 16: 1538–1544 [DOI] [PubMed] [Google Scholar]
- 16. Strasberg B, Pinchas A, Barbash GI, Hod H, Rat S, Har‐Zahav Y, Caspi A, Sclarovsky S, Agmon J: Importance of reciprocal ST segment depression in leads V5 and V6 as an indicator of disease of the left anterior descending coronary artery in acute inferior wall myocardial infarction. Br Heart J 1990; 63: 339–341 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Sclarovsky S, Topaz O, Rechavia E, Strasberg B, Agmon J: Ischemic ST segment depression in V2–V3 on the presenting electrocardiographic feature of posterolateral wall myocardial infarction. Am Heart J 1987; 113: 1085–1090 [DOI] [PubMed] [Google Scholar]
- 18. Mirris DM: Physiologic bases for anterior ST segment depression in patients with acute inferior wall myocardial infarction. Am Heart J 1983; 116: 1308–1322 [DOI] [PubMed] [Google Scholar]
- 19. Edmunds JJ, Gibbons RJ, Bresnahan JF, Clements IP: Significance of anterior ST depression in inferior wall acute myocardial infarction. Am J Cardiol 1994; 73: 143–148 [DOI] [PubMed] [Google Scholar]
- 20. Sclarovsky S, Davidson E, Strasberg B, Lewin RF, Arditi A, Wurtzel M, Agmon J: Unstable angina: The significance of ST segment elevation or depression in patients without evidence of increased myocardial oxygen demand. Am Heart J 1986; 112: 463–467 [DOI] [PubMed] [Google Scholar]
- 21. Struthers AD: Ten years of natriuretic peptide research: A new dawn for their diagnostic and therapeutic use? Br Med J 1994; 308: 1615–1619 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Foy SG, Crozier IC, Richards AM, Nicholas MC, Turner JG, Frampton CM, Ikram H: Neurohormonal changes after acute myocardial infarction. Eur Heart J 1995; 16: 770–778 [DOI] [PubMed] [Google Scholar]
- 23. Osmland T, Bonarjee VVS, Lie RT, Caidahl K: Neurohormonal measurements as indicators of long‐term prognosis after acute myocardial infarction. Am J Cardiol 1995; 76: 230–235 [DOI] [PubMed] [Google Scholar]
- 24. Diamond C, Forrester JS: Effect of coronary artery disease and acute myocardial infarction on left ventricular compliance in man. Circulation 1972; 45: 11–19 [DOI] [PubMed] [Google Scholar]
- 25. Morita E, Yasue H, Yoshimura M, Ogawa H, Jougasaki M, Matsumura T, Mukoyama M, Nakao K: Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation 1993; 88: 82–91 [DOI] [PubMed] [Google Scholar]
- 26. DeCoster PM, Wijns W, Cauwe F, Robert A, Beckers C, Melin JA: Area at risk determination by technetium 99m‐nexakis‐2‐methoxyisobutyl‐isonitrile in experimental reperfused myocardial infarction. Circulation 1990; 82: 2152–2162 [DOI] [PubMed] [Google Scholar]
- 27. Willems JL, Willems RJ, Williams GM, Arnold AEB, Van der Werf F, Verstrade M: Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. Circulation 1990; 82: 1147–1158 [DOI] [PubMed] [Google Scholar]
