Author + information
- Received April 26, 2019
- Revision received May 22, 2019
- Accepted May 22, 2019
- Published online September 30, 2019.
- Shawn H. Reginauld, BSa,
- Valentina Cannone, MD, PhDa,b,
- Seethalakshmi Iyer, MSa,
- Christopher Scott, MSc,
- Kent Bailey, PhDc,
- Jacob Schaefer, BSa,
- Yang Chen, PhDa,
- S. Jeson Sangaralingham, MS, PhDa,d and
- John C. Burnett Jr., MDa,d,∗ ()
- aCardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Clinical Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
- cDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- dDepartment of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. John C. Burnett, Jr., Cardiorenal Research Laboratory, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota 55905.
Objectives This study investigated the differential regulation of circulating atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with acute decompensated heart failure (ADHF) and tested the hypothesis that a relative deficiency of ANP exists in a subgroup of patients with ADHF.
Background The endocrine heart releases the cardiac hormones ANP and BNP, which play a key role in cardiovascular (CV), renal, and metabolic homeostasis. In heart failure (HF), both plasma ANP and BNP are increased as a compensatory homeostatic response to myocardial overload.
Methods ANP and BNP concentrations were measured in a small group of patients with ADHF (n = 112). To support this study’s goal, a total of 129 healthy subjects were prospectively recruited to establish contemporary normal values for ANP and BNP. Plasma 3′,5′cyclic guanosine monophosphate (cGMP), ejection fraction (EF), and body mass index (BMI) were measured in these subjects.
Results In cases of ADHF, 74% of patients showed elevated ANP and BNP. Importantly, 26% of patients were characterized as having normal ANP (21% of this subgroup had normal ANP and elevated BNP). Cyclic GMP was lowest in the ADHF group with normal levels of ANP (p < 0.001), whereas BMI and EF were inversely related to ANP levels (p = 0.003).
Conclusions Among a subgroup of patients hospitalized with ADHF, the presence of an ANP deficiency is consistent with a differential regulation of ANP and BNP and suggests the existence of a potentially compromised compensatory cardiac endocrine response. These findings have implications for the pathophysiology, diagnostics, and therapeutics of human HF.
- acute decompensated heart failure
- atrial natriuretic peptide deficiency
- atrial natriuretic peptide
- natriuretic peptide
Supported by National Heart, Lung and Blood Institute grants R01 HL36634 and RO1 HL13688 to Dr. Burnett and by the Mayo Foundation. Dr. Burnett holds equity in a patent licensed to Zumbro Discovery; and is consultant to Novartis and Ironwood. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2019.
- Revision received May 22, 2019.
- Accepted May 22, 2019.
- 2019 American College of Cardiology Foundation
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