JACCVol. 8, No . 4 cto er 1986:779-83 Hemodynamic Effects o Infused rginine Vasopressin n ongestive HeartFailure STEVEN R. GOLDSMITH, MD, FACC,* ARY S. FRANCIS , MD, FACC,t ALLEN W. COWLEY, JR., PHD \ IRVIN F. GOLDENBERG, MD,§ JAY N. COHN, MD, FACC§ Minneapolis, Minnes ota and Milwaukee , Wi sconsi n 779 The hemodynamic eff ect s of exo gen ously admini ste red arginine vasopressin were assessed in 11 patients wi th chronic congestiveheart failure. Infusion rate s of0.1 to 0. 8 pm ol/ kg pe r m in in cre ase d pl as ma a rgi ni ne va so pressin fr om 6.5 ± 2.7 SD) pg/ml at control to 63 ± 39 pg/ml at the highest infusion rate. There were pro with incr ea ses in systemic vascular resistan ce an d pul monary capillary wedge pr es sur e, but only minimal changes in heart rate and blood pressure. Changes in cardiac output, stroke volume and systemic resistance wer e evi den t from the fir st infus ion rat e, whichincreased plasma arginine vasopressin from 6.5 ± 2.7 to 9.9 ± 4. 6 pg/ml. A pair ed analysis of baseline he mo dynamic data with those measur ed during infusions prod uc ing an argi ni ne vasopr es sin level averaging 15 ± 2.6 pg /ml yie lde d the fo ll ow in g changes: cardiac out put decreased from 4.6 ± 1.2 to 4.2 ± 0.96 liters/min p < 0.01), Arginine vasopressin, the human antidiuretic hormone, is a potent vasoconstrictor l . Numerous st udies 2-5 in the past several years have c le ar ly d em ons tr at ed that it exerts importan t vascular effects at physiologic le ve ls both in nor m al a ni ma ls a nd in a ni ma ls und er a va ri ety of t ype s of s tr es s . We have been interested in a possible role for arginine va so pr es sin in the v as oc ons tr ic ti on of human c ong es ti ve heart fa il ure because th is condition frequently is character i ze d by e le va te d p er ip he ra l va sc ul ar re si st an ce a nd a ct iva tion of other neuroendocrine vasoconstricting systems 6,7) . We 8) and others 9-12 have now shown that plasma F ro m t he * He n ne p in C ou nty a nd t Ve te r an s A dm in is t ra t io n Me d ic al C en te rs , t he § Un iv er si t y o f M in ne s ot a Sc h oo l o f M e di c in e , M in ne ap ol i s , Mi n ne s ot a a nd t h Medical Col lege of Wisconsin. Milwaukee. Wiscon s in . D r. G ol dsm it h is t he r ec ip ie nt o f a C li ni c al I nv es ti ga to r A wa rd f ro m t he N at io na l H e ar t, L un g. a nd B lo od I ns ti tu te . Manusc ript received November 18. 1985; revised manus cr ipt rece ived Ap ril 2 I. 1 98 6, a cc ep te d Ma y I, 1986. Ad dr ess f or r ep ri nt s: St ev en R. G ol ds mi th . MD . H en ne pi n C ou nt y Me dic a l C en t er . C ar di ol ogy S ec ti on . 7 01 P ar k A ve nu e S ou th . M in ne ap olis. Minnesot a 55415. © 1986 by the Amer ic an College of Cardiology stroke volume decrease d from 60 ± 19 to 54 ± 16 ml p < 0. 005) and systemic va scular resistance increased from 1,329 ± 396 to 1,443 ± 395 dynes-s-cm f p = 0.01). Thus , s ma ll in cre ase s i n c ir cul ati ng a rgi ni ne va so pressi n cause mod est but sig nif icant adv ers e circulatory i n c ar di ac ou tp ut , pr ob ably a s a re su lt o f i nc re as ed a f terload, is seen at levelsof arginine vasopressin within the basal range found in conges ti veheart failure. Thes e data de mons tr at e that ci rculating arginine vasopr essi n in physiologic concentrat ions is capa bl e of infl uenc ing hemodynami cs in pati ents with congesti ve heart fail ur e a nd s ugge st t ha t t he ra py f or t hi s c on dit ion d ir ec te d a t inhibi ti on of the vascular effect of arginine va sopressin may be pote ntially us ef ul. Call Cardiol 1986;8:779-83 a rgi ni ne v as op re ss in l eve ls te nd e it he r to be i nc re as ed or t o be i na de qu at el y s upp re ss ed for the pr ev ai li ng p la sm a os molality in patients with heart failure. The c ur re nt study was performed to address the issue of w he th er p hy si ol og ically relevant concent rations of plasma argini ne vasopressin can exert i mpo rt an t h em ody na mi c effects in patients with this condition. Methods Study patients. El even patients wi th chronic congestive heart failure New York Heart Association functional classes II to IV) formed the study group for this investigation. All were receiving digi alis and diuretic drugs and most ad b ee n t re ate d w it h v as od il at in g d ru gs . P at ie nt s w er e a lw ay s studied in a stable clinical state with diuretics and vasodi l at or s d is co nt in ue d a t l ea st 12 hours in advance. The pa tients ages ranged from 20 to 74 years mean 53); 10 were m en , Thr ee ha d i sc he mi c c ar di om yo pa th y d oc um en te d by a history of myocardial infarction or coronary angiography, and eight had i di opa thi c dilated c ar di om yo pa th y. All had 0735-1 097/86/ 3.5 0
