Changes in atrial natriuretic peptide with hemodynamic abnormalities in rheumatic valvular diseases

ABSTRACT

Atrial natriuretic peptide [ANP] plasma levels were studied in 49 patients with rheumatic heart diseases [RHD] and 10 apparently healthy control subjects. Their ages ranged from 6 years to 15 years. All the studied cases were subjected to thorough history taking, clinical examination chest-x ray, EGG, echocardiographic examination and plasma ANP measurement by radiommunoassay. The results revealed that plasma ANP concentration was significantly higher in rheumatic patients as compared to age matched control subjects [P<0.001] and in those suffering from multivalvular disease [MVD] as compared to those with single valve disease [SVD] [P<0.01]. Patients with isolated severe mitral regurge [MR] [grades 4/4 and 314] had higher ANP levels than cases with milder abnormality [grade 2/4]. ANP values in Patients with mitral stenosis [MS] were significantly higher as compared to control subjects [P<0.01] but nearly the same as those with MR. ANP values in Patients with aortic regurge [AR] showed insignificant slight increase as compared to control subjects [P>0.05]. ANP assay proved also to be sensitive in reflecting the development of complications. ANP levels were significantly higher in cases complicated by pulmonary hypertension than those with normal pulmonary artery pressure [P<0.05]. Also, those cases with heart failure had their ANP levels higher than the mean value of ANP in those with compensated RHD. ANP concentration showed a significant positive correlation with cardiothoracic ratio [CTR] in chest roentgenograms [P<0.01]. Also, ANP levels were positively correlated with time measurements of LA/Ao ratio [P<0.01] and left ventricular end-diastotic dimension [LVEDD] [P<0.01] in M-mode echocardiography as well as pulmonary artery systolic pressure in Doppler studies [P<0.05]. There was no significant correlation between ANP level and left ventricular systolic function indices as fractional shortening [ES] and ejection fraction [FS] [P>0.05]. In conclusion, ANP assay can be used for accurate assessment of the degree of the degree of hemodynamic overload in patients with RHD. Also, ANP assay can be of value in delection evaluation and follow-up of potential complications as heart failure and pulmonary hypertension. In addition it could provide a clinically useful marker of the adequacy of treatment of cardiac impairment