A Highly-sensitized Response of B-type Natriuretic Peptide to Cardiac Ischaemia Quantified by Intracoronary Pressure Measurements

Abstract

B-type natriuretic peptide (Bnp) secretion is stimulated by cardiac dysfunction. However, it is unclear how finely myocardial ischaemia contributes to BNP secretion and whether increases in BNP secretion contribute to coronary vasodilation. this study investigated the direct interaction between plasma Bnp levels and cardiac ischaemia using the baseline distal-to-aortic pressure ratio (pd/pa). We examined the baseline Pd/Pa and fractional flow reserve (FFR) in 167 patients with intermediate coronary stenosis. the plasma Bnp level appeared to be associated with the baseline pd/pa in the study population, and this association appeared to become clear only in patients with an ffR ≤ 0.80. To examine the effect of the baseline pd/pa on the Bnp level in these patients, structural equation modeling (SeM) was performed. The baseline Pd/Pa significantly affected the BNP level (β: −0.37, p = 0.003) and the left ventricular ejection fraction (β: 0.43, p = 0.001). To examine the role of BNP in coronary vasodilation, we proposed another path model using a novel value obtained by dividing the ffR by the baseline pd/ Pa (FFR/baseline Pd/Pa) as an index of the hyperaemic response. The BNP level significantly affected the ffR/baseline pd/pa (β: 0.48, p = 0.037). This study demonstrated that BNP finely responded to an exacerbation of cardiac ischaemia and that increases in BNP secretion effectively ameliorated coronary vasoconstriction.B-type natriuretic peptide (BNP) is secreted mainly by the ventricles in heart failure, whereas normal atria secrete A-type natriuretic peptide (ANP) as well as BNP 1-5 . ANP and BNP have a wide range of biological effects; for instance, they induce vasodilation and natriuresis and inhibit the renin-angiotensin aldosterone system (RAAS) and the sympathetic nervous system 6,7 . Plasma BNP is elevated in heart failure caused by various heart diseases, including ischaemic heart disease (IHD) 8-10 .Previous reports have shown that myocardial hypoxia associated with a reduction in coronary blood flow increases cardiac BNP expression 11 . Moreover, the BNP level is elevated during early ischaemia, and an elevated BNP level is a significant risk factor for poor short-term and long-term prognoses 12 . Increases in the plasma BNP level are considered a compensatory response of the heart to ischaemia, because several reports have shown that BNP has a vasodilatory effect on the coronary artery system in humans 13,14 . However, it is still unclear how finely myocardial ischaemia itself contributes to BNP secretion and whether increases in BNP secretion actually induce vasodilation as a counter-adaptation. A precise analysis of the relationship between cardiac ischaemia and BNP secretion is the remaining action assignment.Coronary artery pressure wires are widely used in the clinic to assess the degree of coronary stenosis-induced myocardial ischaemia 15,16 . Pressure wires can be used to measure the fractional flow reserve (FFR), which requires the induction of maximal hyperaemia by drug administration, and the ...

Angina Pektoris Hastalarında B-Tipi Natriüretik Peptit ve Kalsiyum Skoru

“…In recent studies, many mechanisms, including myocardial ischemia, have been shown to contribute to BNP release, and BNP level has also been shown to be a useful clinical indicator in the diagnosis and prognosis of cardiovascular diseases. [10][11][12][13] Furthermore, it has been reported that BNP has vasodilator effects on the coronary artery system and that BNP primarily acts on both epicardial coronary arteries and coronary microvessels. [10,12] Due to its release in response to increased wall tension, it represents a higher degree of myocardial dysfunction in acute coronary syndrome patients with low left ventricular ejection rate and high BNP levels, with a high risk of congestive heart failure and mortality.…”

“…[10][11][12][13] Furthermore, it has been reported that BNP has vasodilator effects on the coronary artery system and that BNP primarily acts on both epicardial coronary arteries and coronary microvessels. [10,12] Due to its release in response to increased wall tension, it represents a higher degree of myocardial dysfunction in acute coronary syndrome patients with low left ventricular ejection rate and high BNP levels, with a high risk of congestive heart failure and mortality. [14] BNP level was found to be higher, particularly in patients with three-vessel involvement.…”

Possible diverse contribution of coronary risk factors to left ventricular systolic and diastolic cavity sizes

“…The path analysis was performed using the IBM SPSS AMOS software program (version 25, Amos Development Corporation, Meadville, PA, USA). We have previously described how to write a path model [5][6][7][8][9][10][11][12][13][14] . In brief, the current models show the relationship between clinical factors and the LV cavity sizes or LVEF using some hierarchical regression models.…”

“…In many areas, SEM plays an important role in understanding how the relationship among observed variables might be generated by an effect of interaction. Recently, we constructed several ideal models of a path diagram due to the solution of some disease status 5 – 14 . In this study, we tried to examine the effect of respective risk factors, such as aging, gender difference, body mass index (BMI), hypertension, diabetes, and dyslipidemia, on LV cavity sizes at the timing of systole and diastole in patients with IHD by using SEM.…”

“…

of a path diagram due to the solution of some disease status [5][6][7][8][9][10][11][12][13][14] . In this study, we tried to examine the effect of respective risk factors, such as aging, gender difference, body mass index (BMI), hypertension, diabetes, and dyslipidemia, on LV cavity sizes at the timing of systole and diastole in patients with IHD by using SEM.

…”