Cardiac natriuretic hormones, neuro-hormones, thyroid hormones and cytokines in normal subjects and patients with heart failure

Abstract

The derangement of neuro-endocrine control of circulation influences both disease evolution and response to treatment in patients with heart failure, but little data are available about the complex relationships between the degree of neuro-hormonal activation and clinical severity. We studied the relationships between cardiac natriuretic hormones (CNHs) and several neuro-hormones and immunological markers in a prospective cohort of 105 consecutive patients with cardiomyopathy (77 men and 28 women, mean age 66.7+/-12.4 years, range 33-89 years). We assayed the circulating levels of CNHs (atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)), plasma renin activity (PRA), aldosterone, cortisol, adrenaline, noradrenaline, thyroid hormones and thyroid stimulating hormone (TSH), tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). The concentrations of all CNHs and neurohormones were higher in patients with heart failure compared to normal subjects, except for free triiodothyronine (FT3), which was below normal values. ANP was positively related to NYHA class, IL-6, adrenaline, noradrenaline and cortisol, while negatively with ejection fraction and FT3. BNP was positively related to age, NYHA class, IL-6, TNF-alpha, adrenaline, noradrenaline and cortisol, while negatively with ejection fraction and FT3. A stepwise multiple linear regression indicated that plasma ANP depended only on ejection fraction, adrenaline and noradrenaline values, while for plasma BNP variation NYHA class contributed too. Our data confirm a progressive activation of hormonal and immunological systems in patients with heart failure. Furthermore, CNH circulating levels in heart failure are affected not only by cardiac function and disease severity, but also by activation of neuro-hormonal and stress-related cytokine systems, as well as by the thyroid hormones, even on usual medical treatment.

The diagnostic and prognostic value of brain natriuretic peptides in adults with a systemic morphologically right ventricle or Fontan-type circulation

“…The association between impaired NYHA class and increased NP levels is in accordance with studies on acquired heart disease, as well as with a small series of congenital heart disease [8][9][10].…”

“…In patients with unchanged NYHA class (n = 26) or ventricular function (n = 21), the natriuretic peptide concentration could go in any direction, and in those with improved ventricular function (n = 12) or functional status (n = 6), neurohormone concentrations generally did not diminish. Other arbitrary cut-off values (10,30 and 40%) were also tested during initial modelling of the data, but this did not improve the discriminatory value of the test. However, higher cut-offs severely reduced the number of patients in whom natriuretic peptide levels changed significantly.…”

The renin–angiotensin system in thyroid disorders and its role in cardiovascular and renal manifestations

“…They observed secondary T 3 hypothyroidism and a marked PRA elevation in these patients but no significant change in ADH or aldosterone, indicating a dissociation of the renin-angiotensin-aldosterone mechanism in brain-dead patients. Emdin et al (2004) also reported that PRA and aldosterone levels were significantly higher in heart failure patients than in healthy subjects and showed a significant linear increase from controls through to patients with severe heart failure, while T 3 and FT 3 levels were significantly decreased in heart failure patients. However, subsequent studies reported normal PRA and aldosterone values in heart failure patients (Pingitore et al 2008, Fontana et al 2012, and Pingitore et al (2008) found a significant decrease in plasma aldosterone but no change in PRA after T 3 infusion.…”

New issues on measurement of B-type natriuretic peptides

“…on average, only an increment of about 50-folds) ( Figure 1 and Table 2), measured by an immunoradiometric assay (IRMA) [5,6]. Of course, the ratio between NTproBNP and BNP is greatly method dependent [5][6][7][8]; as a The plasma concentration values of NT-proBNP, measured by the ECLIA method (Roche Diagnostics, Germany), and BNP, measured by the immunoradiometric assay (IRMA) Shionoria (Shionogi &Co, Japan), are expressed as the ratio between the mean biomarker concentration values found in HF groups and that found in healthy control subjects. Original BNP and NT-proBNP values measured in healthy subjects and patients with heart failure are reported in Table 2 and were previously discussed in detail by Prontera et al [2].…”