Impaired ability to secrete atrial natriuretic peptide in response to isoproterenol infusion in patients with dilated cardiomyopathy

OBJECTIVES: The myocardium has 2 functions in vivo, that of pump and endocrine organ. Therefore, simultaneous examinations of cardiac systolic reserve and endocrine reserve are important in evaluating the activities of the myocardial cells. This study investigated the relationship between cardiac systolic reserve and secretion of atrial natriuretic peptide (ANP) in response to isoproterenol infusion in patients with dilated cardiomyopathy. METHODS: Isoproterenol was infused intravenously in 6 healthy individuals (control group) and 32 patients with dilated cardiomyopathy. The left ventricular systolic responses and plasma ANP concentrations were measured. RESULTS: Patients with dilated cardiomyopathy were classified into 2 groups: patients with a good response (change in fractional shortening > 7%, 17 patients) and those with a poor response (change in < or = 7%, 15 patients). There was no significant difference in end-diastolic dimension, fractional shortening, heart rate, or systolic blood pressure between the 2 groups of patients with dilated cardiomyopathy at rest. The resting plasma ANP concentration in the poor-response group (88.8 +/- 59.0 pg/ml) was significantly higher than that in the other 2 groups (good: 47.0 +/- 35.9 pg/ml, p < 0.05, control: 9.8 +/- 4.1 pg/ml, p < 0.01, respectively). The percentage change in ANP after isoproterenol infusion in the poor-response group (-7.1 +/- 16.7%) was significantly less than that in the other 2 groups (good: 12.6 +/- 27.3%, p < 0.05, control: 31.5 +/- 24.6%, p < 0.01, respectively). CONCLUSIONS: The resting plasma ANP concentration can be used to evaluate the cardiac systolic reserve in patients with dilated cardiomyopathy. Decreased myocardial systolic reserve is also associated with impaired ability to secrete ANP.