Insights into natriuretic peptides in heart failure: An update

Abstract

Natriuretic peptides (NPs) secreted by the heart in response to volume overload are pleiotropic molecules with vasodilating, diuretic, natriuretic, antiproliferative, and antifibrotic actions. Functioning of the NP system is altered in congestive heart failure (CHF), suggesting that support of the NP system might be beneficial in treatment of acute and chronic CHF. Several approaches alone or in combination with other pharmacologic therapies have been shown to enhance function of the NP system: direct administration of native and designer NPs, inhibition of degradation of NPs and their second messenger (cyclic guanosine monophosphate ), and stimulation of cGMP generation. Despite increasing numbers of studies using NPs in therapy of acute and chronic CHF, several controversies regarding safety, efficacy, and dosing of NPs need to be addressed. Moreover, further research is warranted to identify the stages and etiologies of CHF that may profit from NP therapy.

Systems biology and heart failure: concepts, methods, and potential research applications

“…The central idea concerns the potential for the multiple polymorphisms to interact in many complex ways, the net effect of which will determine the impact of the genetic profile on disease expression in an individual patient Heart Fail Rev (2010) 15:371-398 387 will be discussed here in some detail from a systems biology perspective, the natriuretic peptide axis and the reninangiotensin-aldosterone system (RAAS). Each could be considered examples of critical functional modules in the syndrome of heart failure [139,140].…”

A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure

“…Both BNP and BUN/Creat are markers of activation of compensatory pathways; BUN/Creat sodium conserving pathways, and BNP natriuretic and renal preserving pathways. [17, 18] Given that the majority of compensatory pathways evolved to defend circulatory integrity, it does make sense that activation of such pathways at presentation for acute decompensated heart failure could, in the right circumstances , be appropriate and thus not always associated with a poor prognosis. However, when there is apparent failure of the cardio-renal axis to respond to these compensatory pathways it is intuitive that this would be a marker of poor prognosis.…”

Strain Value in the Assessment of Left Ventricular Function and Prediction of Heart Failure Markers in Aortic Regurgitation

“…Natriuretic peptides are vasoactive hormones that play an important role in the regulation of cardiovascular homeostasis. They are synthesized in the myocardium in response to volume overload in the presence of myocytic stretch 21–23 . NT‐proBNP is the amino terminal fragment of the BNP molecule.…”