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Original article| Volume 10, ISSUE 1, P41-44, May 1999

Atrial natriuretic peptide in pulmonary emboli

  • Alexander Adler
    Affiliations
    Department of Medicine, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Edna Peleg
    Affiliations
    Chorley Hypertension Institute, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Tzila Swas
    Affiliations
    Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ehud Grossman
    Affiliations
    Department of Medicine, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Michael Thaler
    Affiliations
    Department of Medicine, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Ilan Goldenberg
    Affiliations
    Department of Medicine, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Talma Rosenthal
    Correspondence
    Corresponding author. Chorley Hypertension Institute, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. Tel.: +972-3-5302624; fax: +972-3-5355428.
    Affiliations
    Chorley Hypertension Institute, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel

    Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for articles by this author

      Abstract

      The potent stimulation of ANP release by alveolar hypoxia raises the possibility that it might be an indicator of pulmonary emboli, a condition which is frequently not diagnosed. ANP was examined in hospitalized patients with pulmonary emboli evidenced by perfusion and ventilation scans, and in two control groups of patients with deep vein thrombosis or anginal syndrome. ANP was measured on days 1, 3, and 5 of hospitalization, while the patients were given heparin, and determined by double antibody radioimmunoassay. The level of ANP was 5 times higher in the pulmonary emboli group than in either of the control groups on day 1, and 3.5–4 times higher than the control groups on day 5. The ANP level remained low in the two control groups throughout the study. We suggest that ANP may serve as an indicator of the presence of pulmonary emboli, facilitating diagnosis of the condition.

      Keywords

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      References

        • Carson J.L.
        • Kelley M.A.
        • Duff A.
        • et al.
        The clinical course of pulmonary embolism.
        N. Engl. J. Med. 1992; 326: 1240-1245
        • Adnot S.
        • Chabrier P.E.
        • Andrivet P.
        • et al.
        Atrial natriuretic peptide concentrations and pulmonary hemodynamics in patients with pulmonary artery hypertension.
        Am. Rev. Respir. Dis. 1987; 136: 951-956
        • Lawrence D.L.
        • Skatrud J.B.
        • Shenker Y.
        Effect of hypoxia on atrial natriuretic factor and aldosterone regulation in humans.
        Am. J. Physiol. 1990; 258: E243-E248
        • Vachiery J.L.
        • Lejeune P.
        • Hallemans R.
        • et al.
        Atrial natriuretic peptide in canine hypoxic pulmonary vasoconstriction.
        Cardiovasc. Res. 1990; 24: 352-357
        • Adnot S.
        • Chabrier P.E.
        • Brun-Buisson C.
        • et al.
        Atrial natriuretic factor attenuates the pulmonary pressor response to hypoxia.
        J. Appl. Physiol. 1988; 65: 1975-1983
        • Jin H.
        • Yang R.H.
        • Thornton R.M.
        • et al.
        Atrial natriuretic peptide lowers pulmonary arterial pressure in hypoxia-adapted rats.
        J. Appl. Physiol. 1988; 65: 1729-1735
        • Jin H.
        • Yang R.H.
        • Chen Y.F.
        • et al.
        Atrial natriuretic peptide in acute hypoxia-induced pulmonary hypertension in rats.
        J. Appl. Physiol. 1991; 71: 807-814
        • Baertschi A.J.
        • Adams J.M.
        • Sullivan M.P.
        Acute hypoxemia stimulates atrial natriuretic factor secretion in vivo.
        Am. J. Physiol. 1988; 255: H295-H300
        • Baertschi A.J.
        • Teague W.G.
        Alveolar hypoxia is a powerful stimulus for ANF release in conscious lambs.
        Am. J. Physiol. 1989; 256: H990-H998
        • Wei Y.
        • Holmberg S.W.
        • Leahy K.M.
        • et al.
        Heparin interferes with the biological effectiveness of atriopeptin.
        Hypertension. 1987; 9: 607-610
        • Zamir N.
        • Haass M.
        • Dave J.R.
        • et al.
        Anterior pituitary gland modulates the release of atrial natriuretic peptides from cardiac atria.
        Proc. Nat. Acad. Sci. U.S.A. 1987; 84: 541-545
        • Worsley D.F.
        • Alavi A.
        Comprehensive analysis of the results of the PIOPED study.
        J. Nucl. Med. 1995; 36: 1280-1287
        • Davidson A.C.
        • Winter R.J.D.
        • Treacher D.F.
        • et al.
        Increased atrial natruretic factor in chronically hypoxemic patients with pulmonary hypertension.
        Am. Rev. Respir. Dis. 1988; 137: 105
        • Burghurer O.C.
        • Hartter E.
        • Punzengruber C.
        • et al.
        Human atrial natriuretic peptide secretion in precapillary pulmonary hypertension. Clinical study in patients with COPD and interstitial fibrosis.
        Chest. 1988; 92: 31-37
        • Burghurer O.C.
        • Hartter E.
        • Weissel M.
        • et al.
        Raised circulating plasma levels of atrial natriuretic peptide in adolescent and adult patients with cystic fibrosis and pulmonary artery hypertension.
        Lung. 1991; 169: 291-300
        • Tunaoglu F.S.
        • Olgunturk F.R.
        • Gokcora N.
        • et al.
        Atrial natriuretic peptide concentrations in children with pulmonary hypertension: correlation with hemodynamic measurements.
        Pediatr. Cardiol. 1994; 15: 288-295
        • Brandt R.R.
        • Wright R.S.
        • Redfield M.M.
        • Burnett J.C.
        Atrial natriuretic peptide in heart failure.
        J. Am. Coll. Cardiol. 1993; 22 (Suppl. A): 87A-92A
        • Lordick F.
        • Hauck R.W.
        • Senekowitsch R.
        • et al.
        Atrial natriuretic peptide in acute hypoxia-exposed healthy subjects and in hypoxaemic patients.
        Eur. Respir. J. 1995; 8: 216-221
        • Winter R.J.D.
        • Meleagros L.
        • Pervez S.
        • et al.
        Atrial natriuretic peptide levels in plasma and in cardiac tissues after chronic hypoxia in rats.
        Clin. Sci. 1989; 76: 95-101
        • Ou L.C.
        • Sardella G.L.
        • Hill N.S.
        • Thorn C.D.
        Does atrial natriuretic factor protect against right ventricular load? I. Hemodynamic study.
        J. Appl. Physiol. 1989; 67: 1606-1611
        • Morice A.H.
        • Pepke-Zaba J.
        • Brown M.J.
        • et al.
        Atrial natriuretic peptide in primary pulmonary hypertension.
        Eur. Resp. J. 1990; 3: 910-913
        • Stein B.C.
        • Levin R.I.
        Natriuretic peptides: physiology, therapeutic potential, and risk stratification in ischemic heart disease.
        Am. Heart J. 1998; 135: 914-923
        • Levin E.R.
        • Gardner D.G.
        • Samson W.K.
        Natriuretic peptides.
        N. Engl. J. Med. 1998; 339: 321-328
        • Noll B.
        • Hein H.
        • Maisch B.
        • et al.
        Changes in atrial natriuretic peptide in patients with lung embolism and obstructive airways disease.
        Pneumologie. 1990; 44: 70-73
        • Bartolucci L.
        • Fioretti M.
        • Rossi G.
        Atrial natriuretic factor (ANF) in massive pulmonary embolism: the effects of heparin treatment.
        Clin. Ther. 1996; 147: 239-244
        • Tan A.C.I.T.L.
        • van Loenhout T.
        • Tan H.S.
        • et al.
        Reciprocal changes in atrial natriuretic peptide levels and plasma renin activity during treatment of pulmonary embolism.
        Am. J. Hypertens. 1989; 2: 570-572
        • Shirai M.
        • Ninomiya I.
        • Shindo T.
        Selective and tone dependent vasodilation of arterial segment in rabbit and feline pulmonary microcirculation in response to ANP.
        Jpn. J. Physiol. 1993; 43: 485-499
        • Raffestin B.
        • Levame M.
        • Eddahibi S.
        • et al.
        Pulmonary vasodilatory action of endogenous atrial natriuretic factor in rats with hypoxic pulmonary hypertension. Effects of monoclonal atrial natriuretic factor antibody.
        Circ. Res. 1992; 70: 184-192
        • Zhao L.
        • Winter R.J.D.
        • Krausz T.
        • et al.
        Effects of continuous infusion of atrial natriuretic peptide on the pulmonary hypertension induced by chronic hypoxia.
        Clin. Sci. 1991; 81: 379-385
        • Kirch W.
        • Schafii C.
        Misdiagnosis at a university hospital in 4 medical areas report on 400 cases.
        Medicine. 1996; 75: 29-40