Clinical significance of plasma atrial and brain natriuretic peptide levels during hemodialysis in hemodialysis patients with old myocardial infarction

OBJECTIVES: The plasma levels of atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) are useful to evaluate left ventricular function in patients with old myocardial infarction(OMI). This echocardiographic study examined the clinical importance of the measurement of ANP and BNP in patients with OMI undergoing hemodialysis. METHODS: ANP and BNP levels were measured before and after hemodialysis in 36 patients with OMI and 42 patients without ischemic heart disease as controls(control group). Echocardiography was performed after hemodialysis. The patients with OMI were classified into two groups according to left ventricular percentage fractional shortening(% FS): Normal(OMI-N) group with %FS > or = 30%(n = 19) and low (OMI-L) group with %FS < 30%(n = 17). RESULTS: The ANP, BNP levels and BNP/ANP ratio before and after hemodialysis were significantly higher in the OMI-L group than in the other groups. BNP level was significantly inversely correlated with %FS(r = -0.60, p < 0.05) and correlated with E wave and E/A, in mitral inflow only in the OMI-L group. The decrease in BNP level during hemodialysis was significantly greater in the OMI-L group than in the other groups, but not in ANP level. CONCLUSIONS: These findings suggest that ANP and BNP levels are increased in patients with left ventricular dysfunction undergoing hemodialysis compared to those with normal left ventricular function. ANP level is convenient for decision of suitable dry weight. In contrast, BNP level that correlated inversely with impairment of left ventricular function is a more sensitive index of left ventricular function than ANP in patients with OMI undergoing hemodialysis.