Atrial Natriuretic Factor in the Pl...

Atrial Natriuretic Factor in the Pleural Fluid of Congestive Heart Failure Patients (*1)

Atrial natriuretic factor (ANF), the recent hormone with potent natriuretic and vasodilatory properties that was originally characterized from cardiac atrial tissue through Debold et al, [1] has been construct to be increased in the plasma of patients with congestive heart failure. [2 3] The circulating concentration of this peptide hormone increases proportionately to the severity of the congestive heart failure. [4 5] Infusion of atrial natriuretic factor has been reported to improve patients with congestive heart failure. [6 7] The not past nor future investigation was designed to determine if patients with congestive heart failure secern ANF into their pleural fluid in an attempt to rid their lung of the exces fluid that is ready in this condition. In this preliminary investigation, ANF was set in the pleural fluid of all of the patients with congestive heart failure, yet whether or not ANF in the pleural fluid helps the lung clear the fluid not absent in congestive heart failure could not be determined from the ready investigation.

PATIENTS AND METHODS

Subjects

Six offers with class 2 New York Heart Association classified congestive heart failure had the concentration of atrial natriuretic factor measured in pleural fluid obtained from a diagnostic thoracocentesis by dint of our previously described methods. [8] A simultaneous plasma sample from the brachial vein was obtained for comparison of the concentration of this peptide hormone in plasma and pleural fluid. These six patients had respirations of 12 to 18 by minute with heart rates of 76 to 92 beats by minute. Their blood compressings ranged from 110/68 to 138/88 mm Hg None of these congestive heart failure patients had any discernible renal impairment with the serum creatinine of all enthralls being below 1.5 mg/dL. The size of the pleural effusions in these patients varied from the same eighth to one half of the same side of the chest based relating to physical examination and confirmed by way of chest x-ray film. Four of these patients were receiving digoxin for therapy at the time of their thoracocentesis, yet diuretics were discontinued in these patients for at least 24 hours prior to thoracocentesis. The other couple subjects presented to the hospital with symptoms of congestive heart failure for the first time. These enslaves were receiving no medications and their thoracocentesis was performed before beginning any therapy. Informed harmony was obtained from each of these congestive heart failure patients after the nature and possible connections of the study were to the full explained. This investigation was approved by dint of the Human Use Committee of the two the University of Arkansas for Medical Sciences and the John L McClellan Memorial Veterans Hospital.

Pleural Fluids

The mean protein concentration of the six thoracocentesis samples was 06 g/L with no individual protein concentration above 08 g/L in the respective pleural fluids. All of these fluids were, thus, transudates which were handled as pursues Ten milliters of each transudate was centrifuged at 3000 g for 15 minutes and then 100 [mu]1 of the supernatant was extracted with 100 percent ethanol (1:1 dilution), vortexed, and allowed to stand for 15 minutes. After this 15-minute period, the pleural fluids were re-centrifuged at 3000 g for 15 minutes and the supernatants taken to drynes with controll nitrogen follow The plasma samples (100 [mu]1 of each) were extracted the same as the pleural fluids. the two plasma and pleural fluids were then examined for their concentration of ANf through radioimmunoassay. Our ANF radioimmunoassay interassay coefficient of variation is 69 percent while the intra-assay coefficient of variation is 57 percent regaining of synthetic unlabeled ANF in this assay is 92[+ or -]11 (SD) percent Our ANF assay has an [EDsub50] of 11 fmols/tube and can find out concentrations as little as 14 fmol of ANF/tube. This assay has estimable parllelism of standard and unknown utilizing collection of standing watered plasma. [8]

RESULTS

The concentration of immunoreactive ANF measured in the pleural fluid of each of six individuals with modern York Heart Association (NYHA) class 2 congestive heart failure is shown in Figure 1 The mean concentration of ANF in the pleural fluid of these patients was 93[+ or -]6 pg/ml (SEM) The concentration of ANF circulating in the plasma of these same individuals is also illustrated in Figure 1 It is important to note that the concentration of ANF in pleural fluid was almost as high as that in the plasma. The mean concentration of ANF in the plasma of these patients with class 2 NYHA congestive heart failure was 95[+ or -]9 pg/ml (SEM) The plasma concentration of ANF in these patients with congestive heart failure was significantly higher (p[is les than]0.001) than that of characters without congestive heart failure, with our normal range of ANF in plasma being 67[+ or -]3 pg/ml (average of 54 normal controls) [8]