Usefulness of the supine-rest maneuver before neurohormonal sampling

Abstract

In congestive heart failure (CHF), several endocrine systems are progressively activated in an attempt to maintain a working hemodynamic. 1 Francis G.S Benedict C Johnstone D.E Kirlin P.C Nicklas J Liang C.S Kubo S.H Rudin-Toretsky E Yusuf S the SOLVD InvestigatorsComparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. Circulation. 1990; 82: 1724-1729 Crossref PubMed Scopus (1276) Google Scholar Measurements of various neurohormones, such as atrial natriuretic factor (ANF), the N-terminal part of its precursor (N-proANF), or the brain natriuretic peptide (BNP), as well as measurements of vasoactive paracrine peptides, such as endothelin-1 (ET-1), are increasingly advocated to evaluate the disease severity or to predict the adverse clinical outcomes. 2 McDonagh T.A Robb S.D Murdoch D.R Morton J.J Ford I Morrison C.E Tunstall-Pedoe H McMurray J.J.V Biochemical detection of left ventricular systolic dysfunction. Lancet. 1998; 351: 9-13 Abstract Full Text Full Text PDF PubMed Scopus (908) Google Scholar , 3 Selvais P.L Donckier J.E Robert A Laloux O Van Linden F Ahn S Ketelslegers J.M Rousseau M.F Cardiac natriuretic peptides for diagnosis and risk stratification in heart failure influences of left ventricular dysfunction and coronary artery disease on cardiac hormonal activation. Eur J Clin Invest. 1998; 28: 636-642 Crossref PubMed Scopus (84) Google Scholar By analogy with norepinephrine assays, it is common practice to use the so-called “30-minute supine rest” maneuver before sampling of these neurohormones. This procedure is supposed to blunt any stress-related changes in catecholamine levels. 4 Benedict C.R Shelton B Johnstone D.E Francis G Greenberg B Konstam M Probstfield J.L Yusuf S the SOLVD InvestigatorsPrognostic significance of plasma norepinephrine in patients with asymptomatic left ventricular dysfunction. Circulation. 1996; 94: 690-697 Crossref PubMed Scopus (288) Google Scholar This time-consuming procedure is certainly a major restriction when considering the implementation of neurohormone measurement as a standard tool in the evaluation or follow-up of large numbers of patients with CHF. Furthermore, it is also often believed that the plasma levels of natriuretic peptides will increase in the supine position and that the plasma levels of ET-1 will decrease. However, this is only an indirect inference from the observed decrease of natriuretic peptide plasma levels and of the increase in ET-1 plasma levels when assuming the upright position. 5 Nicholls D.P Riley M Elborn J.S Stanford C.F Shax C McKillop J.M Buchanan K.D Regulatory peptides in the plasma of patients with chronic cardiac failure at rest and during exercise. Eur Heart J. 1992; 13: 1399-1404 PubMed Google Scholar , 6 Solomon L.R Atherton J.C Bobinski H Green R Effect of posture on plasma immunoreactive atrial natriuretic peptide concentration in man. Clin Sci. 1986; 71: 299-305 Crossref PubMed Scopus (55) Google Scholar , 7 Westendorp R.G.J Roos A.N Riley L.C.M Walma S Frölich M Meinders A.E Chronic stimulation of atrial natriuretic peptide attenuates the secretory response to postural changes. Am J Med Sci. 1993; 306: 371-375 Crossref PubMed Scopus (5) Google Scholar , 8 La Villa G Vena S Conti A Fronzaroli C Brat A Lazzeri C Tosti Guerra C Madiai S Marra N Frachi F Plasma levels of brain natriuretic peptide in healthy subjects and patients with essential hypertension:response to posture. Clin Sci. 1993; 85: 411-416 PubMed Google Scholar , 9 Kaufman H Oribe E Oliver J.A Plasma endothelin during upright tilt relevance for orthostatic hypotension?. Lancet. 1991; 338: 1542-1545 Abstract PubMed Scopus (139) Google Scholar Surprisingly, there is no systematic and comparative study of the effects of this maneuver on the plasma levels of natriuretic or vasoactive peptides. The aim of the present study was to evaluate the real relevance of the supine-rest position in a healthy and cardiac population.