CIRCULATING FORMS OF HUMAN ATRIAL-NATRIURETIC-PEPTIDE IN PATIENTS WITH CONGESTIVE HEART-FAILURE

To elucidate the circulating forms of human atrial natriuretic peptide (hANP) in patients with congestive heart failure (CHF), plasma samples obtained from 36 patients with CHF were analyzed and compared with those from normal subjects. Plasma concentrations of hANP-like immunoreactivity (LI) from normal subjects and patients with mild CHF (class I), as classified by the New York Heart Association (NYHA) functional criteria, did not differ (15 ± 1 vs. 16 ± 1 pmol/L, mean ± se), whereas plasma levels of hANP-LI in patients with moderate and severe CHF significantly (P < 0.01) increased in relation to the severity of CHF (class II, 44 ± 4 pmol/L; class III, 116 ± 24 pmol/L; class IV, 141 ± 21 pmol/L). Reverse-phase HPLC and gel permeation chromatography coupled with RIA for hANP revealed that the circulating forms of hANP-LI consisted of α-hANP, β-hANP, and γ-hANP in CHF, whereas α-hANP predominated in normal plasma. The percentage of β-hANP in total hANP-LI as calculated from the chromatograms by gel filtration was greater in severe CHF (NYHA class III and IV) than those in mild CHF (NYHA class I and II), and apparently exceeded those of other forms. Successful medical treatment for CHF resulted in a marked reduction of total plasma hANP-LI levels with a concomitant disappearance or reduction of β-hANP in 14 patients examined. These data suggest that β-hANP and γ-hANP are secreted from the failing human heart, possibly resulting from the augmented synthesis and/or the altered processing of hANP precursor in cardiocytes, and that circulating β-hANP may serve as a potential marker for the severity of CHF in man. © 1990 by The Endocrine Society.