ELSEVIER zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA International Journal of Cardiology 47 ( 1994) I5 I - I56 Atria1 natriuretic peptide: relation to left ventricular filling properties in patients with systemic sclerosis ’ Elsadig Kazzam* a, Kenneth Caidahlb, Thomas Hednerc, Jan Hedner’. Anders WaldenstrGmd zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQ “Department of Internal Medicine. Uppsalu University Huspirul. S-7Sl 85 Uppsulu. Sweden bDeparrmenr of Clinical Phy_Gology. ‘Depurtmenl of Clinicul Phurmucolog~. Suhlgren ‘s Uniwrsiry Hosprrul. Go/henhwg. Swden, ‘Department of Internul Medicine, Urn4 Uniwrsiry Hospirul. Sweden Received 27 January 1994: revision accepted 3 August 1994 zyxwvutsrqponmlkjihgfedcbaZYXWVU Abstract To determine the relation between left ventricular filling properties and plasma atrial natriuretic peptide in systemic sclerosis, we evaluated 30 consecutive patients and 48 age- and sex-matched controls. The venous plasma atrial natriuretic peptide was measured by radio-immunoassay. Left ventricular involvement was evaluated by echocar- diography and mitral regurgitation was evaluated by Doppler. The patient group had markedly elevated plasma atrial natriuretic peptide as compared to the matched controls (239.4 f 59 vs. 178.2 * 36 pmolil, P < 0.0005). We found signs of impaired left ventricular filling properties among the patients. with an increase of the Doppler A-wave velocity and A/E ratio. A relative reduction of early filling was found in spite of some degree of mitral regurgitation in two- thirds of the patients. The plasma atrial natriuretic peptide concentration was related to the A-wave velocity (r = 0.44. zyxwvutsrqp P < 0.0005), the A/E ratio (r = 0.40, P < 0.005), and also to the degree of mitral regurgitation (r = 0.43. P < 0.005). The relationship to the A-wave velocity remained when considering possible confounding factors. We conclude that the previously observed fibrotic process in systemic sclerosis does not prevent production and liberation of plasma atrial natriuretic peptide in relation to factors distending the left atrium, such as altered left ventricular tilling proper- ties and the presence of mitral regurgitation. However, the moderate relationships between atrial natriuretic peptide and haemodynamic variables indicate that the peptide might also be an independent indicator of cardiac involvement in systemic sclerosis. Keywords: Atrial natriuretic peptide; Diastolic function; Echocardiography; Left ventricle; Mitral regurgitation; Sys- temic sclerosis * Presented in Dart at the 64th Scientific Session of the 1. Introduction American Heart kociation, Anaheim, California, November 14-16 1991. Atria1 natriuretic peptide is a natriuretic, * Corresponding author. diuretic and vasodilating hormone originally Ol67-5273/94/SO7.00 0 1994 Elsevier Science Ireland Ltd. All rights reserved SSDl 0167-5273(94)02170-N