scholarly journals Possible Enzymatic Downregulation of the Natriuretic Peptide System in Patients with Reduced Systolic Function and Heart Failure: A Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Syed S. Zaidi ◽  
Ryan D. Ward ◽  
Kodangudi Ramanathan ◽  
Xinhua Yu ◽  
Inna P. Gladysheva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Natriuretic Peptide ◽  
Systolic Function ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Receptor Blockers ◽  
Peptide System ◽  
Natriuretic Peptide System

Background. In patients with reduced systolic function, the natriuretic peptide system affects heart failure (HF) progression, but the expression of key activating (corin) and degrading enzymes (neprilysin) is not well understood. Methods and Results. This pilot study (n=48) compared plasma levels of corin, neprilysin, ANP, BNP, and cGMP in control patients with normal ejection fractions (mean EF 63±3%) versus patients with systolic dysfunction, with (EF 24±8%) and without (EF 27±7%) decompensated HF (dHF), as defined by Framingham and BNP criteria. Mean ages, use of beta blockers, and ACE-inhibitors-angiotensin receptor blockers were similar between the groups. Corin levels were depressed in systolic dysfunction patients (797±346 pg/ml) versus controls (1188±549, p<0.02), but levels were not affected by dHF (p=0.77). In contrast, levels of neprilysin (p<0.01), cGMP (p<0.001), and ANP (p<0.001) were higher in systolic dysfunction patients than controls and were the highest in patients with dHF. Conclusions. Levels of neprilysin, ANP, BNP, and cGMP increased in patients with reduced systolic function and were the highest in dHF patients. Conversely, corin levels were low in patients with reduced EF with or without dHF. This pattern suggests possible enzymatic downregulation of natriuretic peptide activity in patients with reduced EF, which may have diagnostic and prognostic implications.

Attenuation of Compensation of Endogenous Cardiac Natriuretic Peptide System in Chronic Heart Failure

Circulation ◽  
1997 ◽  
Vol 96 (2) ◽  
pp. 509-516 ◽  
Author(s):  
Takayoshi Tsutamoto ◽  
Atsuyuki Wada ◽  
Keiko Maeda ◽  
Tomoko Hisanaga ◽  
Yukiharu Maeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Peptide System ◽  
Natriuretic Peptide System

scholarly journals Natriuretic Peptides and Analytical Barriers

2017 ◽  
Vol 63 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Vlad C Vasile ◽  
Allan S Jaffe
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Myocardial Function ◽  
Specific Assay ◽  
Peptide System ◽  
Cardiovascular Homeostasis ◽  
Natriuretic Peptide System

Abstract BACKGROUND The natriuretic peptide system is an endocrine, autocrine and paracrine system that plays an important role in the maintenance of cardiovascular homeostasis. Biomarkers based on these peptides are important diagnostic and prognostic tools for myocardial function. CONTENT Although natriuretic peptides were discovered more than 2 decades ago, their intricate and complex biology is associated with important questions not yet elucidated. The diversity of circulating forms of natriuretic peptides, the distinct expression of these forms in particular patients, and the heterogeneity of heart failure forms, along with specific assay-related and preanalytic issues, cause assays to be poorly harmonized. SUMMARY This review presents the relevant issues related to the biology of natriuretic peptides and differences between assays with immediate implications for clinical practice.

Natriuretic peptide system is not exhausted in severe heart failure

2009 ◽  
Vol 10 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Patrícia Lourenço ◽  
Ana Azevedo ◽  
José Paulo Araújo ◽  
Paulo Bettencourt
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Severe Heart Failure ◽  
Peptide System ◽  
Natriuretic Peptide System

scholarly journals Review: Effective Implementation of the New ESC Guidelines for the Management of Chronic Heart Failure in Routine Clinical Practice

2005 ◽  
Vol 6 (2_suppl) ◽  
pp. S6-S10 ◽  
Author(s):  
Karl Swedberg
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
High Dose ◽  
Mortality And Morbidity ◽  
European Guidelines ◽  
Receptor Blockers

European guidelines for the management of chronic heart failure (CHF) have been recently updated. Key changes include emphasis on CHF with preserved ejection fraction, and recognition of the role of angiotensin receptor blockers (ARBs) in the management of CHF patients with left ventricular systolic dysfunction who remain symptomatic despite optimal therapy, or who are intolerant to angiotensin-converting enzyme (ACE) inhibitors. Recent trials that clearly demonstrated significant mortality and morbidity benefits were integral to these new recommendations. Additionally, a high dose of an ARB, as demonstrated in the Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) programme, can significantly reduce hospitalisation for heart failure in these settings. The guidelines recommend that only those ARBs and doses used in clinical trials should be considered, taking into account current licensed indications. Clinicians who are directly involved in the management of CHF must play a key role in the dissemination of these guidelines to colleagues to ensure that optimal CHF management is integrated into standard practice.

scholarly journals The Management of Heart Failure with Preserved Ejection Fraction

2015 ◽  
Vol 1 (1) ◽  
pp. 11 ◽  
Author(s):  
Andrew JS Coats ◽  
Louise G Shewan ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Clinical Syndrome ◽  
Aldosterone Antagonists ◽  
Sharp Separation ◽  
Clinical Trial Evidence ◽  
Receptor Blockers

Heart failure is defined as a clinical syndrome and is known to present with a number of different pathophysiological patterns. There is a remarkable degree of variation in measures of left ventricular systolic emptying and this has been used to categorise heart failure into two separate types: low ejection fraction (EF) heart failure or HF-REF and high EF heart failure or HF-PEF. Here we review the pathophysiology, epidemiology and management of HF-PEF and argue that sharp separation of heart failure into two forms is misguided and illogical, and the present scarcity of clinical trial evidence for effective treatment for HF-PEF is a problem of our own making; we should never have excluded patients from major trials on the basis of EF in the first place. Whilst as many heart failure patients have preserved EFs as reduced we have dramatically under-represented HF-PEF patients in trials. Only four trials have been performed in HF-PEF specifically, and another two trials that recruited both HF-PEF and HF-REF can be considered. When we consider the similarity in outcomes and neurohormonal activation between HF-REF and HF-REF, the vast corpus of trial data that we have to attest to the efficacy of various treatment (angiotensinconverting-enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], beta-blockers and aldosterone antagonists) in HF-REF, and the much more limited number of trials of similar agents showing near statistically significant benefits in HF-PEF the time has come rethink our management of HF-PEF, and in particular our selection of patients for trials.

scholarly journals Home HealthCare Telemonitoring System for “Medication Titration” in the Treatment of Heart Failure: Architecture for an Interoperable Solution

2017 ◽  
Vol 11 (21) ◽  
Author(s):  
Henry Hermel Andrade Caicedo ◽  
Juan Camilo Vanegas Serna ◽  
Geiner Giovanny Barbosa Casanova
Keyword(s):  
Heart Failure ◽  
Medical Devices ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Cardiac Cells ◽  
Home Healthcare ◽  
Commercial Application ◽  
Receptor Blockers ◽  
Pressure Meter ◽  
Whole Heart

Heart failure is a common condition in which the heart is unable to keep up with its workload. Therefore, oxygen and nutrients are no longer able to reach the cardiac cells, which worsens the situation of the whole heart. Treating an HF patient is challenging due to the co-morbidities and the numerous medications associated with the treatment. Medical dosage through titration of ACE inhibitors (ACEIs), Angiotensin receptor blockers (ARBs), beta-blockers and other drugs is a recommended procedure to reduce morbidity and mortality in HF patients. However, the procedure is performed under medical supervision at the hospital, lasting from one to four weeks. We propose a telemonitoring system to help clinicians to follow the patient through the Medication Titration procedure at home. We used commercial medical devices, certified on international communication standards to assure interoperability. Independently of the producer or brand, they can operate properly in the designed architecture. So far, we are able to connect two medical devices, blood pressure meter and weight scale, to a data hub. Then the data is rerouted to the cloud, where information is stored in a database. We use a commercial application to visualize the data through a friendly graphical interface.

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