| BackgroundCongestive heart failure(CHF) is a clinical syndrom which has a complex pathophysiolgical mechanism.lt is important to recongnise the progressive mechanism of CHF,detect its early-term diagnosis index,treat patients of CHF as early as possible and prevent the development of CHF. More recently,cardiovascular system is not only a circulating tissue,but also has an important endocrine function,including cardiomyocyte,vasculaur endothelial cell(VEC) and vascular smooth muscle cell(VSMC) which can secret many kinds of bioactive molecule.lt is important for the changs of these active molecule of plasma levels to predict the progress and prognosis in patients with CHF. Adrenomedullin(ADM) is a novel vasoactive peptide originally isolated from human pheochromocytoma tissue in 1993. Its proadrenomedullin was divided by endogenous peptidase into 3 active fragments,including proadrenomedullin N-terminal 20 peptide(PAMP),ADM,adrenotensin(ADT).The actions of ADM are including vasodilatation,reduction of arterial pressure,diuretic and natriuretic properties,inhibition of angiotension II-stimulated aldosterone production,et al.The actions of PAMP are identical to those of ADM.But the actions of ADT are opposite to those of ADM and PAMP,including vasoconstrictation,hypertension,et al. There is not only intramolecule regulation actions among the bioactive peptides processing from the same precursor of ADM,but also intermolecule regulation actions among the ADM and ANP in the progression of CHF. In addition,many studies showed that plasma ADM levels in patients with CHF were increased along with the increase of plasma ANP levels. The plasma levels of ADM and ANP were decreased at the same time after drug treatment. It is suggested that there is a regulative relationship among these cardiovascular active peptides,which constitutes a complex and refined network regulative system to prevent the deterioration of CHF. Although the different changs in plasma levels of these active peptides in the developmentof CHF,they might commonly be involved in the pathophysiogical process in the developing process of CHF and can provide theorical basis for clinically treatment and judgement of prognosis in patients with CHF. ObjectiveTo investigate the relationship of plasma levels of adrenomedullin(ADM),proadrenomedullin N-terminal 20 peptide(PAMP),adrenotensin(ADT) and atrial natriuretic peptide(ANP) in patients with congestive heart failure. Methdsl.Left ventricular distolic diamension (LVDd),left ventricular ejection fraction (LVEF) were measured with echocardiogram in 45 patients with congestive heart failure (CHF) and 20 controls.2.Cardiothoracic ratio (CTR) was assessed with thoracic photographs in 45 patients with CHF and 20 controls .3.Plasma levels of ADM,PAMP,ADT and ANP were measured by specific radioimmunoassay in 20 controls and 45 patients with CHF before and after treatment. Results1. There were no significant differences in sex and age among groups of class IL IIL IV and controls. LVEF was significantly decreased in patients of class III and IV as compared with those of controls(P<0.05),but there was no significance between the class II and controls. LVDd was significantly increased in patients of class III,IV as compased with those of class II and controls.The chang of CTR was identical to that of LVDd.2. Plasma PAMP levels were decreased in class ILIILIV as compared with controls,there was significantly difference in plasma PAMP levels in class IV as compared with class IL IIL controls(P<0.05),but not significant between class IL III and controls. After treatment,plasma PAMP levels in all patients had no changs as compared with before treatment.3. Plasma ADM levels were significantly increased in class IL III as compared with controls(P<0.05). In class IV,plasma ADM levels wassignificantly decreased as compared with class II, III and controls(P<0.05). After treatment, there were significantly decreased in class II and III as compared with before treatment (P<0.05).
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