Effects of Atrial Natriuretic Peptide on Hemodynamics, Neurohormonal Factors and Inflammatory Cytokines in Patients with Compensated Heart Failure Due to Idiopathic Dilated Cardiomyopathy

Background: A recombinant human atrial natriuretic peptide (ANP) has been reported to have multiple cardiovascular effects such as diuresis, vasodilation, and suppression of neurohormonal activity. However, few clinical investigations exist for the immune-modulating effects of ANP. Thus, we investigated if ANP modulates inflammatory cytokines as well as hemodynamics and neurohormonal factors in patients with compensated heart failure (CHF) due to idiopathic dilated cardiomyopathy (DCM). Methods: Sixty DCM patients were recruited and divided randomly into two groups, the placebo group and the ANP group. In the ANP group, blood sampling for the measurements of norepinephrine (NE), brain natriuretic peptide (BNP), rennin (PRA), aldosterone (PAC), tumor necrosis factor-alpha (TNF-a), interleukin-6 (IL-6) and interleukin-10 (IL-10) and tissue Doppler echocardiography were performed five days before and just before continuous infusion of ANP for 96 hours and immediately and seven days after termination. Results: ANP significantly improved left ventricular filling and decreased BNP, NE, PAC and TNF-a, IL-6 levels, whereas significantly increased IL-10 levels from 0.78 ± 0.05 pg/ml to 8.63 ± 0.64 pg/ml (p < 0.001). In ANP group, both TNF-a/IL-10 and IL-6/IL-10 decreased from 57.03 ± 4.76 to 3.41 ± 0.46 (p < 0.001) and from 6.72 ± 0.63 to 0.23 ± 0.03 (p < 0.001), respectively and these effects remained unchanged for seven days after termination. Conclusion: ANP improved an imbalance in the cytokine network as well as hemodynamics and neurohormonal factors of CHF due to DCM.