Neuroendocrine hormone status and diuretic response to atrial natriuretic peptide in patients with acute heart failure

Abstract

Aims Given the various effects of sacubitril/valsartan in heart failure, a deeper understanding of atrial natriuretic peptide (ANP) actions is warranted. Natriuresis is a fundamental action of ANP in acute heart failure (AHF), whereas the diuretic effect of ANP is different in each patient according to the diversity of renal response to ANP, which is affected by baseline plasma ANP status and deficiency of circulating ANP. Meanwhile, associations between other neuroendocrine hormones and the diuretic response to ANP are unclear. This study investigated the impact of pivotal neuroendocrine hormones on the diuretic effects of exogenous ANP, carperitide. Methods and results Plasma ANP, renin, aldosterone, and vasopressin levels and the diuretic effect of 0.0125 μg/kg/min of carperitide alone for the first 6 h were prospectively evaluated in 75 patients with AHF. Lower ANP levels were significantly associated with a greater diuretic response to exogenous ANP (r = −0.35, P = 0.002). Additionally, higher vasopressin levels were significantly related to the poor diuretic effects of exogenous ANP (r = −0.54, P < 0.001). Plasma ANP and vasopressin concentrations were not significantly correlated (r = 0.19, P = 0.10). Baseline systolic blood pressure, renal function, and prior use of loop diuretics did not predict the diuretic response to exogenous ANP, whereas vasopressin levels independently predicted a diuretic response to exogenous ANP (P < 0.001), as well as lower plasma ANP levels (P = 0.027). Conclusions Vasopressin status was significantly associated with the diuretic response to exogenous ANP in AHF, independent of plasma ANP status. The results may provide a better understanding of the actions of sacubitril/valsartan.

Renal Denervation Ameliorates Cardiomyocyte Apoptosis in Myocardial Ischemia–Reperfusion Injury Through Regulating Mitochondria–Endoplasmic Reticulum Contact

“…Current research has confirmed that ARNI can inhibit neuroendocrine over-activation, exerting favorable sodium excretion, vasodilatation, diuresis, etc., thus promoting the improvement of the condition of heart failure. 43 , 44 ARNI has now become a category of recommendation for the treatment of patients with heart failure. The purpose of this trial is to clarify whether RDN is equally effective in improving cardiac function by comparing RDN with ARNI.…”

Novel cutting edge nano‐strategies to address old long‐standing complications in cardiovascular diseases. A comprehensive review

“…60 Management of HF aims at addressing both hemodynamic compromise and reperfusion to restore myocardial contractile function. [61][62][63] Although the HF market has numerous well-established therapies and the pipeline is promising, there is a considerable level of unmet needs.…”

Loop diuretics in heart failure: The objective markers to guide the therapy are needed

“…This is probably why the more advanced HF patients (patients who take diuretics for longer periods of time) need higher doses of the drugs 8 . The diuretic response is also highly related to the neurohormonal drive, which can also identify patients with more disrupted pathophysiology and worse outcomes 9–11 . Several studies have demonstrated the association between the dose of diuretics and the outcomes, but this has never been demonstrated in a casual‐effect manner as most of the data come from retrospective analyses or registries 12,13 .…”

“… 8 The diuretic response is also highly related to the neurohormonal drive, which can also identify patients with more disrupted pathophysiology and worse outcomes. 9 , 10 , 11 Several studies have demonstrated the association between the dose of diuretics and the outcomes, but this has never been demonstrated in a casual‐effect manner as most of the data come from retrospective analyses or registries. 12 , 13 Unfortunately, at the moment, we lack objective measures that allow us to adjust the loop diuretic doses in HF patients.…”