These findings indicate that total adiponectin is more useful for assessing mortality risk than HMW adiponectin and a high plasma total adiponectin is an independent prognostic predictor especially in CHF patients with normal BMI.

These findings suggest that decreased clearance from the kidney contributes to the elevated BNP in CHF patients with renal dysfunction, especially in patients with an eGFR <60 ml/min.

Methods PatientsStudy 1 Fifty consecutive patients with mild to severe CHF (left ventricular ejection fraction (LVEF) <45%, New York Heart Association (NYHA) functional classes II-IV) underwent diagnostic cardiac catheterization. Patients taking allopurinol, with renal failure, malignancy or congenital malformations of the heart or vessels were excluded. Renal failure was defined as an estimated glomerular filtration rate (eGFR) <30 ml · min -1 · (1.73 m 2 ) -1 according to the MDRD equation. 20 Informed consent was given by all patients before participating in the study, and the protocol Background A recent study suggested that xanthine oxidase is activated in congestive heart failure (CHF). However, whether uric acid (UA) is secreted from the failing heart remains unknown, so it is currently unclear whether serum UA can provide prognostic information independent of brain natriuretic peptide (BNP). Methods and ResultsSerum UA was measured in the aortic root (AO) and the coronary sinus (CS) of 74 patients with CHF. The serum UA level was significantly higher in the CS than in the AO. The transcardiac gradient of UA (CS -AO) increased with the severity of CHF, inversely correlated with left ventricular ejection fraction (LVEF) and positively correlated with left ventricular end-diastolic volume index. The plasma levels of norepinephrine, BNP, UA, and LVEF were monitored prospectively in 150 CHF patients for a mean follow-up of 3 years. High plasma levels of UA (p<0.001) and BNP (p<0.001) were shown by multivariate stepwise analysis to be independent predictors of mortality. Conclusions High plasma UA level, partly secreted from the failing heart, is a prognostic predictor independent of BNP in patients with CHF. Monitoring a combination of BNP and UA may be useful for the management of patients with CHF. (Circ J 2006; 70: 1006 -1011

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Background: The adipocyte-specific cytokine adiponectin, has cardioprotective effects, correlates with endogenous cardiac natriuretic peptides and adipocyte has guanylyl cyclase-A receptors of natriuretic peptides. Aims: To evaluate the effect of carperitide (atrial natriuretic peptide; ANP) on plasma adiponectin in patients with heart failure. Methods and results: Seventy-five patients admitted to our hospital with decompensated heart failure were randomised (1:2) to nitroglycerin (group I: n = 23) or carperitide infusion (group II: n = 52). Blood samples were collected at baseline and after 7 days. Plasma levels of total and high-molecular weight (HMW) adiponectin, ANP and brain natriuretic peptide (BNP) were measured. There were no differences in baseline characteristics between the two groups. In group I, plasma levels of total and HMW adiponectin were significantly decreased (21.1 ± 2.5 to 18.6 ± 2.5 µg/mL, p b 0.05, 12.3 ± 1.8 to 10.8 ± 1.7 µg/mL, p b 0.05, respectively) concomitant with the decrease in plasma levels of ANP and BNP. In group II, plasma levels of total and HMW adiponectin were significantly increased (17.3 ± 1.3 to 19.7 ± 1.6 µg/mL, p b 0.0001, 9.8 ± 1.0 to 10.5 ± 1.0 µg/mL, p b 0.05, respectively) concomitant with the increase in ANP. Conclusions: These findings indicate that carperitide infusion increases plasma levels of total and HMW adiponectin in patients with heart failure.

Background: Cardiotrophin-1 (CT-1) is a member of the interleukin (IL-6) family of cytokines and is increased in patients with chronic heart failure (CHF). Aims: To evaluate the prognostic role of CT-1 in patients with CHF. Methods and results: We measured the plasma levels of CT-1, brain natriuretic peptide (BNP), and IL-6 in 125 patients with CHF. Patients were monitored for a mean follow-up period of 2.9 years. Plasma levels of CT-1 increased with severity of CHF. There was a significant negative correlation between plasma CT-1 and left ventricular ejection fraction. There was a significant correlation between plasma CT-1 and log IL-6. During the follow-up period, 37 patients died. High plasma levels of CT-1, BNP, and IL-6 were independent predictors of mortality on stepwise multivariate analysis. The hazard ratio for mortality in patients with plasma BNP N 170 pg/mL and CT-1 N 658 fmol/mL was 2.48 (95% confidence interval, 1.217-5.060) compared to those with plasma BNP N 170 pg/mL and CT-1 b 658 fmol/mL (p = 0.0124). Conclusion: These findings indicate that plasma CT-1 measurement provides additional prognostic information and that combined levels of CT-1 and BNP are more accurate at predicting mortality in patients with CHF than either marker alone.

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To prevent cardiovascular disease, targeting aldosterone synthesis and release may be clinically important.Aldosterone production in the adrenal gland is mediated mainly by the T-type calcium channel in vitro.Efonidipine inhibits both L-and T-type Ca channels. To compare the effects of efonidipine on neurohumoral factors with those of amlodipine, an L-type Ca channel blocker, we studied 40 essential hypertensive outpatients. Forty patients who had been administered amlodipine for more than 1 year were treated with efonidipine for 6 months in place of amlodipine. Substituting efonidipine for amlodipine had no significant effect on clinic systolic blood pressure or the plasma levels of brain natriuretic peptide, norepinephrine or active renin. However, the heart rate was significantly decreased (72.0 ± 1.3 vs. 69.8 ± 1.3 beats/min, p <0.01) and the plasma aldosterone level was also significantly decreased after efonidipine treatment (97.7 ± 7.9 vs. 79.7±5.6 pg/mL, p <0.0001). Changes in the aldosterone