How Does Treatment Influence Endocrine Mechanisms in Acute Severe Heart Failure? Effects on Cardiac Natriuretic Peptides, the Renin System, Neuropeptide Y and Catecholamines

Abstract

1. Hormones involved in cardiovascular regulation are influenced by drug treatment. It is therefore difficult to study endocrine mechanisms in heart failure as most patients are already on treatment by the time they reach hospital. 2. We studied nine hospital in-patients before and after treatment of acute New York Heart Association class IV heart failure. 3. Before treatment, plasma brain and atrial natriuretic peptides were markedly elevated (BNP 121 +/- 26 pg/ml, ANP 163 +/- 33 pg/ml; normal range: BNP 3.9 +/- 0.3 pg/ml, ANP 8.6 +/- 0.8 pg/ml) and correlated positively with serum creatinine and left ventricular end-diastolic diameter and negatively with ejection fraction. Eight patients improved and one died. 4. With improvement plasma ANP and BNP fell. Initial renin activity was within the normal range but increased on treatment. Plasma neuropeptide Y and adrenaline remained normal before and after treatment in the eight patients who improved. Initial plasma noradrenaline was in the normal range in four of these patients and just above normal in a further four. In the patient who died, initial plasma neuropeptide Y and catecholamines were very high. 5. Plasma BNP emerged as complementary to ANP as a dynamic index in severe heart failure; however, renal function is also an important determinant of plasma BNP and ANP. There is little evidence for activation of the circulating renin-angiotensin-aldosterone system or neuropeptide Y before treatment of acute heart failure.

Prevalence and misdiagnosis of chronic heart failure in nursing home residents: the role of B-type natriuretic peptides

“…[16][17][18][19] In contrast with other studies, they were not influenced by gender nor by the use of renin-angiotensin system blockers. [20][21][22] A limitation of the study is the small population of 103 nursing home residents, in one centre, which could lead to a selection bias in arriving at the prevalence of CHF of 23%. On the other hand, our prevalence of chronic heart failure is in line with the prevalence in other nursing home residents and in the elderly.…”

Molecular Heterogeneity Has a Major Impact on the Measurement of Circulating N-Terminal Fragments of A- and B-Type Natriuretic Peptides

“…Before immunization, the peptide immunogens NT-proANP [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] , NTproBNP , NT-proBNP [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] , NT-proBNP 10 -29 , NTproBNP [41][42][43][44][45][46][47][48][49][50][51][52][53][54]…”

“…The following assay buffer was used for all dilutions: 0.04 mol/L sodium hydrogen phosphate, 0.01 mol/L sodium dihydrogen phosphate, 0.1 mol/L NaCl, 1 g/L gelatin, 0.5 mL/L Triton X-100, pH 7.4. Calibrators (60 -6000 pmol/L) or plasma or serum samples were pipetted in duplicates of 25 L and incubated for 16 -24 h at 4°C with 100 L of antiserum solution (1:20 000 dilution for antiserum to NT-proANP 46 -79 and 1:40 000 dilution for antiserum to NT-proANP [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] ) and 100 L of tracer solution containing ϳ8000 cpm of the appropriate radioiodinated peptide. Bound and free fractions were separated by precipitation with donkey anti-goat IgG (Scantibodies Laboratory, Inc., and Linco Research, Inc.) in 0.5 mL of 80 g/L polyethylene glycol 6000 containing normal goat serum as a carrier.…”

“…Otherwise, the procedure was identical to that described above. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Calibrators (62.5-1000 pmol/L recombinant NT-proBNP) or plasma or serum samples were pipetted in duplicates of 50 L and incubated for 16 -24 h at 4°C with 100 L of antiserum solution at a dilution 1:14 000.…”

“…The median effective concentration (EC 50 ) for the NT-proANP 1-20 assay was 1236 pmol/L, and that for the NT-proANP 46 -79 assay was 389 pmol/L. The EC 50 values for the different NT-proBNP assays (NT-proBNP , NT-proBNP [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] , NT-proBNP 10 -29 , and NT-proBNP 57-76 ) were 383, 325, 576, and 520 pmol/L, respectively. The within-and between-assay imprecisions (CVs) were always Ͻ15% and Ͻ20%, respectively, and usually were markedly better ( Table 2).…”