Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications

Abstract

The incidence of heart failure with preserved ejection fraction (HFpEF) is increasing and its challenging diagnosis and management combines clinical, imagistic and biological data. Natriuretic peptides (NPs) are hormones secreted in response to myocardial stretch that, by increasing cyclic guanosine monophosphate (cGMP), counteract myocardial fibrosis and hypertrophy, increase natriuresis and determine vasodilatation. While their role in HFpEF is controversial, most authors focused on b-type natriuretic peptides (BNPs) and agreed that patients may show lower levels. In this setting, newer molecules with an increased specificity, such as middle-region pro-atrial natriuretic peptide (MR-proANP), emerged as promising markers. Augmenting NP levels, either by NP analogs or breakdown inhibition, could offer a new therapeutic target in HFpEF (already approved in their reduced EF counterparts) by increasing the deficient cGMP levels found in patients. Importantly, these peptides also retain their prognostic value. This narrative review focuses on NPs’ physiology, diagnosis, therapeutic and prognostic implication in HFpEF.

Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM, MR-proANP, hs-CRP and sP-selectin plasma levels in the perioperative period

“…The biomarkers were thawed once and analysed in batches, so inter-individual relationships between the levels of the biomarkers are most likely correct. Furthermore, the preoperative baseline plasma concentrations of MR-proADM, MR-proANP and hs-CRP concur with those found in previous studies (Tegnell et al 2002;Morgenthaler et al 2005, Charitakis et al 2016. Figure 3.…”

“…Our study indirectly confirms these findings by describing the plasma level dynamics of MR-proANP, where an earlier peak in the level of MR-proANP was observed on Days 1-2 compared to that previously described for NT-proBNP, occurring around Days 3-4 postoperatively (Reyes et al 2005). It may be that ANP is stored in granules within the myocardium ready for secretion, whereas BNP must be synthesised before secretion (Tanase et al 2019). Theoretically, this implies that in the early phase after cardiac surgery ANP could be a better prognostic marker than BNP for severe postoperative heart failure.…”

“…operated with open heart surgery (Tegnell et al 2002), CRP was seen to reach a peak level of around 200 mg/L on Day 3 postoperatively. In that study, the first measurement after the preoperative one was on Day 1 postoperatively.…”

“…CRP is extensively used in everyday clinical practice for the evaluation inflammatory processes. CRP plasma levels associated with cardiac surgery have been described previously (Tegnell et al 2002) and hs-CRP postoperatively have been measured in conjunction with heart surgery (Noly et al 2019). However, to our knowledge CRP dynamics throughout the whole perioperative period, in particular hs-CRP, have not previously been described.…”

Prognostic value of heart failure echocardiography index in HF patients with preserved, mid-ranged and reduced ejection fraction

“…NT-proBNP is a cardiac neurohormone secreted by the ventricles, playing an important role in the diagnosis and prognosis of HF [14,15]. However, studies have shown that plasma NT-proBNP level in patients with chronic kidney disease and cor pulmonale are also significantly increased, so NT-proBNP is not the specific diagnostic criterion for HF [16].…”