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Ogawa M, Hori Y, Kanno N, Iwasa N, Toyofuku T, Isayama N, Yoshikawa A, Akabane R, Sakatani A, Miyakawa H, Hsu HH, Miyagawa Y, Takemura N. Comparison of N-terminal pro-atrial natriuretic peptide and three cardiac biomarkers for discriminatory ability of clinical stage in dogs with myxomatous mitral valve disease. J Vet Med Sci 2021; 83:705-715. [PMID: 33551383 PMCID: PMC8111352 DOI: 10.1292/jvms.20-0629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Plasma N-terminal pro-atrial natriuretic peptide (NT-proANP) concentration increases with
progression of myxomatous mitral valve disease (MMVD) in dogs. This multicentre,
prospective study compared plasma NT-proANP, N-terminal pro-brain natriuretic peptide
(NT-proBNP), ANP, and cardiac troponin I (cTnI) concentrations in dogs with MMVD for their
characteristics and discriminatory ability to detect cardiac dilatation and congestive
heart failure (CHF). Thirty-six healthy dogs and 69 dogs with MMVD were included. Clinical
variables were obtained via physical examination, thoracic radiography, and
echocardiography. The discriminatory ability of each cardiac biomarker (CB) to determine
the presence or absence of cardiac dilatation (event 1) and CHF (event 2) was evaluated
using the receiver operating characteristic curves. Plasma NT-proANP, NT-proBNP, and ANP
concentrations showed a significant association with the left atrium/aorta ratio
(P<0.01). The area under the curve of plasma NT-proANP and NT-proBNP
concentrations were 0.72 and 0.75, respectively in event1 and 0.72 and 0.76, respectively
in event2. Plasma NT-proANP and NT-proBNP concentrations showed sensitivity 80.0 and
80.0%; specificity 67.6 and 64.7% in event1 (cutoff value; 8,497.81 pg/ml and 1,453.00
pmol/l, respectively) and sensitivity 85.7 and 81.0%; specificity 60.4 and 64.6% in event2
(cutoff value; 8,684.33 pg/ml and 1,772.00 pmol/l, respectively). In dogs with MMVD,
plasma NT-proANP, NT-proBNP, and ANP concentrations increase with left atrial enlargement.
Particularly, plasma NT-proANP and NT-proBNP concentrations appeared to be equally useful
in the discriminatory ability to detect cardiac dilatation and CHF.
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Affiliation(s)
- Mizuki Ogawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Yasutomo Hori
- Otsuka-Ekimae Animal Hospital, 1-20-7 Kitaotsuka, Toshima-ku, Tokyo 170-0004, Japan
| | - Nobuyuki Kanno
- Saitama Animal Medical Centre, 2-2-15 Sayamadai Iruma-shi, Saitama 358-0033, Japan
| | - Naoki Iwasa
- Hashima Animal Hospital, 2-17 Asahira, Fukujyu-cho, Hashima, Gifu 501-6255, Japan
| | - Takeshi Toyofuku
- Nishigahara Rose Animal Hospital, 1-25-32 Nishigahara, Kita-ku, Tokyo 114-0024, Japan
| | - Noriko Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito-ku, Tokyo 114-0024, Japan
| | - Akane Yoshikawa
- Meguro Animal Medical Center, 3-9-3-104 Meguro, Meguro-ku, Tokyo 153-0063, Japan
| | - Ryota Akabane
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Atsushi Sakatani
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Hirosumi Miyakawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Huai-Hsun Hsu
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Yuichi Miyagawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Naoyuki Takemura
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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Pereira NL, Tosakulwong N, Scott CG, Jenkins GD, Prodduturi N, Chai Y, Olson TM, Rodeheffer RJ, Redfield MM, Weinshilboum RM, Burnett JC. Circulating atrial natriuretic peptide genetic association study identifies a novel gene cluster associated with stroke in whites. ACTA ACUST UNITED AC 2014; 8:141-9. [PMID: 25452597 DOI: 10.1161/circgenetics.114.000624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The goal of this study was to identify genetic determinants of plasma N-terminal proatrial natriuretic peptide (NT-proANP) in the general community by performing a large-scale genetic association study and to assess its functional significance in in vitro cell studies and on disease susceptibility. METHODS AND RESULTS Genotyping was performed across 16 000 genes in 893 randomly selected individuals, with replication in 891 subjects from the community. Plasma NT-proANP1-98 concentrations were determined using a radioimmunoassay. Thirty-three genome-wide significant single-nucleotide polymorphisms were identified in the MTHFR-CLCN6-NPPA-NPPB locus and were all replicated. To assess the significance, in vitro functional genomic studies and clinical outcomes for carriers of a single-nucleotide polymorphism rs5063 (V32M) located in NPPA that represented the most significant variation in this genetic locus were assessed. The rs5063 variant allozyme in transfected HEK293 cells was decreased to 55±8% of wild-type protein (P=0.01) as assessed by quantitative western blots. Carriers of rs5063 had lower NT-proANP levels (1427 versus 2291 pmol/L; P<0.001) and higher diastolic blood pressures (75 versus 73 mm Hg; P=0.009) and were at an increased risk of stroke when compared with wild-type subjects independent of age, sex, diabetes mellitus, hypertension, atrial fibrillation, and cholesterol levels (hazard ratio, 1.6; P=0.004). CONCLUSIONS This is the first large-scale genetic association study of circulating NT-proANP levels performed with replication and functional assessment that identified genetic variants in the MTHFR-CLCN6-NPPA-NPPB cluster to be significantly associated with NT-proANP levels. The clinical significance of this variation is related to lower NT-proANP levels, higher blood pressures, and an increased risk of stroke in the general community.
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Affiliation(s)
- Naveen L Pereira
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN.
| | - Nirubol Tosakulwong
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Christopher G Scott
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Gregory D Jenkins
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Naresh Prodduturi
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Yubo Chai
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Timothy M Olson
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Richard J Rodeheffer
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Margaret M Redfield
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - Richard M Weinshilboum
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
| | - John C Burnett
- From the Division of Cardiovascular Diseases, Department of Internal Medicine (N.L.P., T.M.O., R.J.R., M.M.R., J.C.B.), Department of Biomedical Statistics and Informatics (N.T., C.G.S, G.D.J., N.P.), and Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics (N.L.P., R.M.W.), Mayo Clinic, Rochester, MN
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Rutten JHW, Boomsma F, van den Meiracker AH. Higher renal extraction of ANP compared with NT-proANP, BNP and NT-proBNP. Eur J Clin Invest 2006; 36:514-5. [PMID: 16796610 DOI: 10.1111/j.1365-2362.2006.01652.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Voors AA, Petrie CJ, Petrie MC, Charlesworth A, Hillege HL, Zijlstra F, McMurray JJ, van Veldhuisen DJ. Low pulse pressure is independently related to elevated natriuretic peptides and increased mortality in advanced chronic heart failure. Eur Heart J 2005; 26:1759-64. [PMID: 15833758 DOI: 10.1093/eurheartj/ehi270] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS An increased pulse pressure (PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure (CHF). In contrast, a decreased PP was related to increased mortality in patients with acute decompensated heart failure. However, the predictive value of PP in patients with advanced CHF is not known. METHODS AND RESULTS PP was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with New York Heart Association Class III or IV CHF (mean age 65 and mean ejection fraction 0.26). Natriuretic peptides were measured in a subgroup. Multivariable Cox-regression analysis demonstrated that lower PP was associated with an increased mortality [hazard ratio (HR) 0.91 per 10 mmHg; 0.93-0.99], independent of mean arterial pressure (MAP) and other well known prognostic markers. In patients with a PP below the median value of 45 mmHg, PP was a stronger predictor of mortality than MAP (HR for PP 0.80 per 10 mmHg; 0.64-0.99). In patients with a PP above the median value of 45 mmHg, MAP was a stronger predictor of mortality than PP (HR for MAP 0.83 per 10 mmHg increase; 0.72-0.95). In addition, lower PP was independently related to increased atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP). CONCLUSION In patients with advanced CHF, low PP is an independent predictor of mortality. In addition, low PP was related to increased levels of ANP and BNP.
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Affiliation(s)
- Adriaan A Voors
- Department of Cardiology, Thoraxcenter, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.
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Hogenhuis J, Voors AA, Jaarsma T, Hillege HL, Boomsma F, van Veldhuisen DJ. Influence of age on natriuretic peptides in patients with chronic heart failure: a comparison between ANP/NT-ANP and BNP/NT-proBNP. Eur J Heart Fail 2005; 7:81-6. [PMID: 15642536 DOI: 10.1016/j.ejheart.2004.03.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Revised: 02/11/2004] [Accepted: 03/26/2004] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Natriuretic peptides are currently used in the diagnosis and follow-up of patients with Chronic Heart Failure (CHF). However, it is unknown whether there are different influences of age on atrial natriuretic peptide (ANP)/N-terminal-ANP (NT-ANP) or B-type natriuretic peptide (BNP)/N-terminal-proBNP (NT-proBNP). AIMS To compare the influence of age and gender on plasma levels of ANP/NT-ANP and BNP/NT-proBNP in CHF patients. METHODS AND RESULTS Natriuretic peptides were measured in 311 CHF patients (68+/-8 years, 76% males, left ventricular ejection fraction (LVEF) 0.23+/-0.08). All natriuretic peptides were significantly related to age (p<0.05) on multivariate regression analysis, with partial correlation coefficients of 0.18, 0.29, 0.28 and 0.25 for ANP, NT-ANP, BNP and NT-proBNP, respectively. The relative increase of both BNP/NT-proBNP were more pronounced than of ANP/NT-ANP (p<0.01). Furthermore, the relative increase of BNP with age was markedly larger than of NT-proBNP (p<0.01). Levels of all natriuretic peptides were also significantly related to cardiothoracic ratio, renal function and LVEF. CONCLUSION In patients with CHF, BNP/NT-proBNP were more related to age than ANP/NT-ANP, and BNP was more related to age than NT-proBNP. However, in these CHF patients the influence of age on the levels of all natriuretic peptides was modest, and comparable to several other factors.
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Affiliation(s)
- Jochem Hogenhuis
- Thoraxcenter, Department of Cardiology, University Hospital Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands
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Metry G, Hall C, Wikström B, Källskog V, Hansell P, Danielson B. Fluid balance in patients with chronic renal failure assessed with N-terminal proatrial natriuretic peptide, atrial natriuretic peptide and ultrasonography. ACTA ACUST UNITED AC 2001; 171:117-22. [PMID: 11350271 DOI: 10.1046/j.1365-201x.2001.00792.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The N-terminal proatrial natriuretic peptide (proANP) has become an important parameter for assessing the prognosis of patients with cardiac disease. Its use for evaluating the hydration status in patients with chronic renal failure, however, is still under investigation. The present study comprised 12 haemodialysis (HD) and 17 pre-dialysis patients. In the HD patients, the inferior vena cava diameter during quiet expiration (IVCe) was estimated by ultrasonography and plasma concentrations of N-terminal proANP, atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) were measured before and 4 h after termination of HD. In the pre-dialysis patients venous blood samples were taken during rest to measure plasma N-terminal proANP and ANP and serum creatinine. Normal values for N-terminal proANP and ANP were obtained from 18 healthy volunteers. The plasma concentrations of N-terminal proANP and ANP in healthy volunteers were 328 +/- 92 and 11.4.0 +/- 3.1 pM L-1, respectively. In pre-dialysis patients, serum creatinine ranged from 110 to 447 microM L-1 and was significantly correlated to plasma N-terminal proANP (r = 0.60, P < 0.05) but not to ANP. This may indicate that N-terminal proANP is more dependent on renal function for its clearance than ANP, which is probably cleared by extrarenal mechanisms as well. In HD patients, IVCe was significantly correlated to the three hormones before HD, most strongly to N-terminal proANP. After dialysis, IVCe was significantly correlated to ANP and cGMP but was not correlated to N-terminal proANP. This may suggest that proANP takes a longer time than other hormones to reflect changes in intravascular volume. In conclusion, N-terminal proANP is a hormone closely related to degree of renal function. Furthermore, it is a sensitive marker reflecting the interdialytic hydration status in HD patients, as indicated by its high correlation to IVCe, a standard method which is used frequently nowadays to assess the body hydration. However N-terminal proANP could not reflect the acute changes in fluid volume induced by HD, probably because it is slowly metabolized.
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Affiliation(s)
- G Metry
- Department of Internal Medicine, Nephrology Section, Uppsala University, Sweden
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Mair J, Hammerer-Lercher A, Puschendorf B. The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure. Clin Chem Lab Med 2001; 39:571-88. [PMID: 11522102 DOI: 10.1515/cclm.2001.093] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The long-predicted endocrine function of the heart has been proven by the discovery of atrial natriuretic peptide (atrial natriuretic factor, A-type natriuretic peptide; ANP) 20 years ago. This subsequently led to the description of a whole family of structurally similar but genetically distinct peptides, the natriuretic peptide family, which contributes to cardiovascular homeostasis. These looped peptides promote natriuresis and diuresis, act as vasodilators, and exert antimitogenic effects on cardiovascular tissues. Two members, ANP and brain natriuretic peptide (B-type natriuretic peptide; BNP) are secreted by the heart mainly in response to myocardial stretch induced by volume load. The natriuretic peptides are synthesized as preprohormones. The C-terminal endocrinological active peptides (ANP, BNP) and their N-terminal prohormone fragments are found in plasma. The natriuretic peptide system is activated to its highest degree in ventricular dysfunction. However, natriuretic peptides are increased in all patients with edematous disorders which lead to an increase in atrial tension or central blood volume, such as renal failure or ascitic liver cirrhosis. It could be demonstrated that in chronic heart failure patients and during the subacute phase of myocardial infarction, of all tested neurohormones, the cardiac natriuretic peptides were best markers to identify heart failure and the most powerful predictors of morbidity and mortality. Natriuretic peptides are independent markers for risk assessment. In comparative studies BNP was superior to ANP and its N-terminal prohormone fragments in myocardial infarction as well as in chronic heart failure patients. Less data on N-terminal proBNP (NT-proBNP) is available, but BNP and NT-proBNP appear to be equivalent markers. For primary care physicians natriuretic peptide measurement is useful to decide which patient with suspected heart failure warrants further investigation, particularly when assessment of left ventricular function is not readily available. Natriuretic peptides have an excellent negative predictive value, particularly in high risk patients. An increase in BNP is serious enough to warrant follow-up examinations. For the cardiologists the natriuretic peptides are helpful for guidance of therapy and monitoring disease course in heart failure patients and for risk stratification in heart failure and myocardial infarction.
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Affiliation(s)
- J Mair
- Department of Internal Medicine, University of Innsbruck School of Medicine, Austria.
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van Kats JP, Duncker DJ, Haitsma DB, Schuijt MP, Niebuur R, Stubenitsky R, Boomsma F, Schalekamp MA, Verdouw PD, Danser AH. Angiotensin-converting enzyme inhibition and angiotensin II type 1 receptor blockade prevent cardiac remodeling in pigs after myocardial infarction: role of tissue angiotensin II. Circulation 2000; 102:1556-63. [PMID: 11004147 DOI: 10.1161/01.cir.102.13.1556] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mechanisms behind the beneficial effects of renin-angiotensin system blockade after myocardial infarction (MI) are not fully elucidated but may include interference with tissue angiotensin II (Ang II). METHODS AND RESULTS Forty-nine pigs underwent coronary artery ligation or sham operation and were studied up to 6 weeks. To determine coronary angiotensin I (Ang I) to Ang II conversion and to distinguish plasma-derived Ang II from locally synthesized Ang II, (125)I-labeled and endogenous Ang I and II were measured in plasma and in infarcted and noninfarcted left ventricle (LV) during (125)I-Ang I infusion. Ang II type 1 (AT(1)) receptor-mediated uptake of circulating (125)I-Ang II was increased at 1 and 3 weeks in noninfarcted LV, and this uptake was the main cause of the transient elevation in Ang II levels in the noninfarcted LV at 1 week. Ang II levels and AT(1) receptor-mediated uptake of circulating Ang II were reduced in the infarct area at all time points. Coronary Ang I to Ang II conversion was unaffected by MI. Captopril and the AT(1) receptor antagonist eprosartan attenuated postinfarct remodeling, although both drugs increased cardiac Ang II production. Captopril blocked coronary conversion by >80% and normalized Ang II uptake in the noninfarcted LV. Eprosartan did not affect coronary conversion and blocked cardiac Ang II uptake by >90%. CONCLUSIONS Both circulating and locally generated Ang II contribute to remodeling after MI. The rise in tissue Ang II production during angiotensin-converting enzyme inhibition and AT(1) receptor blockade suggests that the antihypertrophic effects of these drugs result not only from diminished AT(1) receptor stimulation but also from increased stimulation of growth-inhibitory Ang II type 2 receptors.
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Affiliation(s)
- J P van Kats
- Department of Internal Medicine I, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Relationship between different natriuretic peptides and severity of naturally acquired mitral regurgitation in dogs with chronic myxomatous valve disease. J Vet Cardiol 2000; 2:7-16. [DOI: 10.1016/s1760-2734(06)70002-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Knight EL, Fish LC, Kiely DK, Marcantonio ER, Davis KM, Minaker KL. Atrial natriuretic peptide and the development of congestive heart failure in the oldest old: a seven-year prospective study. J Am Geriatr Soc 1999; 47:407-11. [PMID: 10203114 DOI: 10.1111/j.1532-5415.1999.tb07231.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial natriuretic peptide (ANP) levels are elevated in symptomatic heart failure and correlate with invasively measured left heart pressures. OBJECTIVE To examine the association between plasma ANP level and the subsequent development of congestive heart failure (CHF) in older subjects with no history of CHF. DESIGN A 7-year, prospective, blinded, cohort study. SETTING A life care facility in Boston, Massachusetts. PARTICIPANTS Two hundred fifty-six frail older subjects (mean age 88 +/- 7) with no history of CHF at study entry. MAIN OUTCOME MEASURE Clinical episodes of CHF with confirmatory chest roentgenogram findings. Cox proportional hazard analyses were performed to examine the relationship between ANP levels and the development of CHF while controlling for 19 clinical, physical, and laboratory parameters. A Kaplan-Meier estimator (log-rank test) was used to determine if the development of CHF differed by tertile of ANP. RESULTS During the follow-up period, 32% of the cohort developed CHF. The mean ANP level in the CHF group was 95 pmol/L +/- 11 pmol/L versus 60 pmol/L +/- 5 pmol/L in the no CHF group (two tailed t test P = .005). On multivariate analysis, a high ANP level was found to be associated significantly (P = .01) with the development of CHF. CONCLUSIONS There is a statistically significant association between ANP level and the subsequent development of CHF in frail older individuals with no history of CHF.
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Affiliation(s)
- E L Knight
- Harvard Medical School Division on Aging, and Massachusetts General Hospital, Boston, USA
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Wijbenga AA, Balk AH, Jonkman FA, Boomsma F, Simoons ML, Man in t Veld AJ. Relation of atrial natriuretic peptides to left ventricular systolic and diastolic function in heart failure. Eur J Heart Fail 1999; 1:51-8. [PMID: 10937980 DOI: 10.1016/s1388-9842(98)00005-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Plasma concentrations of atrial natriuretic peptides are correlated with atrial pressures, as are left ventricular ejection fraction and left ventricular filling abnormalities. AIMS This study investigated the relation of atrial natriuretic peptides to both left ventricular systolic and diastolic function in heart failure. METHODS Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were measured in 63 patients with chronic heart failure and left ventricular systolic dysfunction. According to Doppler transmitral flow measurements, 19 patients had a restrictive and 44 patients had a non-restrictive left ventricular filling pattern. RESULTS Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were higher in patients with a restrictive filling pattern than in patients with a non-restrictive filling pattern (197 vs. 75 pmol/l, P<0.0001 and 1.14 vs. 0.45 nmol/l, P<0.0001). In univariate analysis, atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide correlated with deceleration time, E/A ratio and left ventricular ejection fraction. In multivariate analysis, both peptides appeared independently related to left ventricular ejection fraction and left ventricular filling pattern. CONCLUSION In patients with chronic heart failure, atrial natriuretic peptides provide information on left ventricular systolic as well as diastolic function.
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Affiliation(s)
- A A Wijbenga
- Heart Center, University Hospital Rotterdam, The Netherlands.
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Saxena R, Wijnhoud AD, Man in 't Veld AJ, van den Meiracker AH, Boomsma F, Przybelski RJ, Koudstaal PJ. Effect of diaspirin cross-linked hemoglobin on endothelin-1 and blood pressure in acute ischemic stroke in man. J Hypertens 1998; 16:1459-65. [PMID: 9814616 DOI: 10.1097/00004872-199816100-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE For almost 50 years it has been known that hemolysed blood can increase blood pressure. Although preclinical studies suggest that this pressor response is due to an interaction of hemoglobin with endothelium-derived vasoactive substances, its mechanism in humans is unknown. We investigated the involvement of endothelin-1 in the blood pressure response to the oxygen carrier diaspirin cross-linked hemoglobin (DCLHb) in stroke patients. DESIGN In a randomized phase II study, increasing doses of DCLHb (25, 50 and 100 mg/kg, n=8, 8 and 11, respectively) or placebo (n=26) were infused intravenously every 6 h for 72 h to patients with an acute ischemic stroke. Blood pressure and heart rate were measured every 15 min and plasma concentrations of endothelin-1, catecholamines, renin, vasopressin and atrial natriuretic peptide were measured before and 24 and 66 h after the start of the infusions. RESULTS In the placebo group, mean arterial pressure (MAP) was 112 (109-115) mmHg (mean and 95% confidence interval) at baseline and decreased spontaneously by 11.4 (5.4-17.5) and 12.5 (5.4-19.5) mmHg after 24 and 66 h, respectively. This decrease in MAP was attenuated in patients treated with DCLHb, reaching statistical significance in the highest dose group. The plasma endothelin-1 concentration decreased slightly in the placebo group, from 4.2 (3.1-5.3) pg/ml (median and range) at baseline to 2.4 (1.9-3.7) pg/ml after 24 h (P=0.0044) and 2.8 (1.9-3.7) pg/ml after 66 h (P=0.0042), but increased dose-dependently in response to DCLHb infusion. With the highest dose of DCLHb, the plasma endothelin-1 concentration rose from 4.8 (0.1-7.8) pg/ml at baseline to 21.2 (13.4-53.2) pg/ml after 24 h (P< 0.001) and to 27.6 (11.9-47.8) pg/ml after 66 h (P< 0.001). The increases in the plasma endothelin-1 concentration and in MAP were correlated (r=0.30, P=0.02). Other vasoactive hormones were not affected by the DCLHb infusion. CONCLUSIONS Infusion of DCLHb in patients with acute ischemic stroke was associated with a dose-dependent increase in plasma endothelin-1 concentration. This may underlie the attenuation by DCLHb of the natural decrease in blood pressure that we observed in these patients.
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Affiliation(s)
- R Saxena
- Department of Neurology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
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Tuinenburg AE, Van Veldhuisen DJ, Boomsma F, Van Den Berg MP, De Kam PJ, Crijns HJ. Comparison of plasma neurohormones in congestive heart failure patients with atrial fibrillation versus patients with sinus rhythm. Am J Cardiol 1998; 81:1207-10. [PMID: 9604948 DOI: 10.1016/s0002-9149(98)00092-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Plasma atrial natriuretic peptide and endothelin are further elevated in patients with congestive heart failure and atrial fibrillation, compared to those with sinus rhythm. The higher plasma endothelin suggests that vasoconstriction is an important mechanism for hemodynamic compensation in these patients.
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Affiliation(s)
- A E Tuinenburg
- Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands
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Numata Y, Dohi K, Furukawa A, Kikuoka S, Asada H, Fukunaga T, Taniguchi Y, Sasakura K, Tsuji T, Inouye K, Yoshimura M, Itoh H, Mukoyama M, Yasue H, Nakao K. Immunoradiometric assay for the N-terminal fragment of proatrial natriuretic peptidein human plasma. Clin Chem 1998. [DOI: 10.1093/clinchem/44.5.1008] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Recently, the N-terminal fragment of proatrial natriuretic peptide (N-terminal proANP) has been proposed as a marker of chronic congestive heart failure. In this study, we established a two-step immunoradiometric assay using monoclonal antibodies and synthetic N-terminal proANP (1–67) as a standard. It allows us to measure plasma N-terminal proANP in only 4 h without prior extraction. The detection limit of this assay was 15 pmol/L for a 100 μL sample of plasma. Within-run CVs ranged from 1.7% to 2.9% and between-run CVs ranged from 4.2% to 5.1%. The dilution curves of plasma samples showed good linearity and analytical recovery was 89–104%. The mean (±SD) N-terminal proANP in plasma of 33 healthy subjects was 188 (±71) pmol/L and 1030 (±411) pmol/L in 25 patients with heart failure. Our immunoradiometric assay is rapid and precise enough for routine determination of N-terminal proANP in human plasma.
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Affiliation(s)
- Yoshito Numata
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Keiji Dohi
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Ayako Furukawa
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Shino Kikuoka
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Hidehisa Asada
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Takahiro Fukunaga
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Yasushi Taniguchi
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Kazuyuki Sasakura
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Tetsuo Tsuji
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Ken Inouye
- Diagnostic Science Division, Shionogi & Company, Ltd., 2-5-1 Mishima, Settsu-shi, Osaka 566, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Kumamoto University of Medicine School, Kumamoto 860, Japan
| | - Hiroshi Itoh
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto 606, Japan
| | - Masashi Mukoyama
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto 606, Japan
| | - Hirofumi Yasue
- Division of Cardiology, Kumamoto University of Medicine School, Kumamoto 860, Japan
| | - Kazuwa Nakao
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto 606, Japan
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