Hemodynamic, renal, and hormonal effects of adrenomedullin infusion in patients with congestive heart failure

• Published in: Circulation (New York, N.Y.) Vol. 101; no. 5; pp. 498 - 503
• Main Authors: NAGAYA, N, SATOH, T, MASUDA, Y, MIYATAKE, K, KANGAWA, K, NISHIKIMI, T, UEMATSU, M, FURUICHI, S, SAKAMAKI, F, OYA, H, KYOTANI, S, NAKANISHI, N, GOTO, Y
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 08.02.2000; American Heart Association, Inc
• Subjects: Adrenomedullin; Biological and medical sciences; Cardiology. Vascular system; Cardiotonic Agents - therapeutic use; Female; Heart; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hemodynamics - drug effects; Hormones - blood; Humans; Injections, Intravenous; Kidney - drug effects; Male; Medical sciences; Middle Aged; Peptides - therapeutic use; Human; Heart failure; Pharmacologic test; Intravenous administration; Heart disease; Adrenomedullin; Cardiovascular disease; Hemodynamics; Kidney
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.101.5.498

Experimental studies have shown that adrenomedullin (AM) causes vasodilatation, diuresis, and a positive inotropic effect. In humans, however, whether infusion of AM has beneficial effects in congestive heart failure (CHF) remains unknown. Hemodynamic, renal, and hormonal responses to intravenous infusion of human AM (0.05 microg. kg(-1). min(-1)) were examined in 7 patients with CHF and 7 normal healthy subjects (NL). In NL group, AM significantly decreased mean arterial pressure (-16 mm Hg, P<0. 05) and increased heart rate (+12 bpm, P<0.05). In CHF group, AM also decreased mean arterial pressure (-8 mm Hg, P<0.05) and increased heart rate (+5 bpm, P<0.05), but to a much lesser degree (P<0.05 versus NL). AM markedly increased cardiac index (CHF, +49%; NL, +39%, P<0.05) while decreasing pulmonary capillary wedge pressure (CHF, -4 mm Hg; NL, -2 mm Hg, P<0.05). AM significantly decreased mean pulmonary arterial pressure only in CHF (-4 mm Hg, P<0.05). AM increased urine volume (CHF, +48%; NL, +62%, P<0.05) and urinary sodium excretion (CHF, +42%; NL, +75%, P<0.05). Only in CHF, plasma aldosterone significantly decreased during (-28%, P<0.05) and after (-36%, P<0.05) AM infusion. These parameters remained unchanged in 7 patients with CHF and 6 healthy subjects who received placebo. Intravenous infusion of AM has beneficial hemodynamic and renal effects in patients with CHF.