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Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failure.
Int J Cardiol. 2005 Sep 15; 104(1):39-45.IJ

Abstract

BACKGROUND

Atrial and brain natriuretic peptides (ANP and BNP) plasma concentration increases and holds a prognostic significance in patients with left ventricular dysfunction. We assessed the hypothesis that right ventricular (RV) overload might significantly contribute to plasma elevation of cardiac natriuretic hormones in patients with heart failure.

METHODS

Forty-one patients with cardiomyopathy and depressed left ventricular (LV) function (ejection fraction, EF, <40%), underwent cardiac magnetic resonance imaging (MRI) and resting plasma determination of ANP and BNP. Nineteen healthy subjects were also studied as control group. Ventricular volumes and function were assessed by MRI.

RESULTS

In the group of patients, LVEF was 22.6+/-1.2% (controls: 61.2+/-1.3%, P<0.001, mean+/-S.E.M.), while RVEF was 48.2+/-2.5% (controls: 66.7+/-1.6%, P<0.001); LV and RV end diastolic/systolic volumes, corrected by body surface area, were 143+/-7/114+/-7 ml/m2 (controls 70+/-3/27+/-2 ml/m2, both P<0.001) and 66+/-3/37+/-4 ml/m2 (controls: 63+/-4/21+/-2 ml/m2, P<0.01 only for end-systolic volume). BNP plasma value was on average 324+/-39 pg/ml (range: 23-1280, controls 10+/-2 pg/ml), ANP value was 144+/-17 pg/ml (range: 26-534, controls 15+/-1 pg/ml). BNP positively correlated with either end-diastolic or end-systolic RV volume in patients, less with LV systolic, and not with LV diastolic volume. Moreover, a significant negative correlation was observed between BNP and either LVEF or RVEF. Conversely, ANP showed a significant correlation only with end-systolic RV volume and with both RVEF and LVEF. When multivariate stepwise linear regression analysis was applied LVEF resulted the only independent predictor for ANP plasma values (R=0.591, P<0.001), while LVEF and RV end-diastolic volume for BNP (R=0.881, P<0.001, and R=0.881, P=0.035, respectively).

CONCLUSIONS

Right heart overload contributes independently to plasma elevation of natriuretic peptides. RV involvement, which is known to independently worsen prognosis in patients with cardiomyopathy, might contribute to their established prognostic power, inducing compensatory secretion of plasma cardiac natriuretic hormones.

Authors+Show Affiliations

Institute of Clinical Physiology, National Research Council, Pisa, Italy. passino@ifc.cnr.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16137508

Citation

Passino, Claudio, et al. "Right Heart Overload Contributes to Cardiac Natriuretic Hormone Elevation in Patients With Heart Failure." International Journal of Cardiology, vol. 104, no. 1, 2005, pp. 39-45.
Passino C, Maria Sironi A, Favilli B, et al. Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failure. Int J Cardiol. 2005;104(1):39-45.
Passino, C., Maria Sironi, A., Favilli, B., Poletti, R., Prontera, C., Ripoli, A., Lombardi, M., & Emdin, M. (2005). Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failure. International Journal of Cardiology, 104(1), 39-45.
Passino C, et al. Right Heart Overload Contributes to Cardiac Natriuretic Hormone Elevation in Patients With Heart Failure. Int J Cardiol. 2005 Sep 15;104(1):39-45. PubMed PMID: 16137508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failure. AU - Passino,Claudio, AU - Maria Sironi,Anna, AU - Favilli,Brunella, AU - Poletti,Roberta, AU - Prontera,Concetta, AU - Ripoli,Andrea, AU - Lombardi,Massimo, AU - Emdin,Michele, PY - 2004/03/18/received PY - 2004/08/10/revised PY - 2004/09/04/accepted PY - 2005/9/3/pubmed PY - 2006/8/9/medline PY - 2005/9/3/entrez SP - 39 EP - 45 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 104 IS - 1 N2 - BACKGROUND: Atrial and brain natriuretic peptides (ANP and BNP) plasma concentration increases and holds a prognostic significance in patients with left ventricular dysfunction. We assessed the hypothesis that right ventricular (RV) overload might significantly contribute to plasma elevation of cardiac natriuretic hormones in patients with heart failure. METHODS: Forty-one patients with cardiomyopathy and depressed left ventricular (LV) function (ejection fraction, EF, <40%), underwent cardiac magnetic resonance imaging (MRI) and resting plasma determination of ANP and BNP. Nineteen healthy subjects were also studied as control group. Ventricular volumes and function were assessed by MRI. RESULTS: In the group of patients, LVEF was 22.6+/-1.2% (controls: 61.2+/-1.3%, P<0.001, mean+/-S.E.M.), while RVEF was 48.2+/-2.5% (controls: 66.7+/-1.6%, P<0.001); LV and RV end diastolic/systolic volumes, corrected by body surface area, were 143+/-7/114+/-7 ml/m2 (controls 70+/-3/27+/-2 ml/m2, both P<0.001) and 66+/-3/37+/-4 ml/m2 (controls: 63+/-4/21+/-2 ml/m2, P<0.01 only for end-systolic volume). BNP plasma value was on average 324+/-39 pg/ml (range: 23-1280, controls 10+/-2 pg/ml), ANP value was 144+/-17 pg/ml (range: 26-534, controls 15+/-1 pg/ml). BNP positively correlated with either end-diastolic or end-systolic RV volume in patients, less with LV systolic, and not with LV diastolic volume. Moreover, a significant negative correlation was observed between BNP and either LVEF or RVEF. Conversely, ANP showed a significant correlation only with end-systolic RV volume and with both RVEF and LVEF. When multivariate stepwise linear regression analysis was applied LVEF resulted the only independent predictor for ANP plasma values (R=0.591, P<0.001), while LVEF and RV end-diastolic volume for BNP (R=0.881, P<0.001, and R=0.881, P=0.035, respectively). CONCLUSIONS: Right heart overload contributes independently to plasma elevation of natriuretic peptides. RV involvement, which is known to independently worsen prognosis in patients with cardiomyopathy, might contribute to their established prognostic power, inducing compensatory secretion of plasma cardiac natriuretic hormones. SN - 0167-5273 UR - https://www.unboundmedicine.com/medline/citation/16137508/Right_heart_overload_contributes_to_cardiac_natriuretic_hormone_elevation_in_patients_with_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(05)00124-5 DB - PRIME DP - Unbound Medicine ER -