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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The important neuroendocrine systems implicated in heart failure are reviewed here, with special emphasis on their possible role in pathophysiology and the chances of pharmacological intervention. The part played by the sympathetic nervous system and the renin-angiotensin-aldosterone system and the beneficial effects of beta-blockers, ACE inhibitors, and angiotensin II antagonists are well-established. The involvement of vasopressin, endothelin-1, ANP, BNP, and TNF-alpha and the interventional possibilities relating to these hormones are also discussed. It is concluded that, in addition to the known interventional principles of neuroendocrine activation, there is a series of new exciting principles and some of them might become important in the future.
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PMID:[Neuroendocrine activation in heart failure I. Pathophysiology and pharmacological intervention]. 1109 49

Neurohumoral systems activated in heart failure are reviewed in relation to prognostic and diagnostic information. Plasma levels of noradrenaline, renin, vasopressin, endothelin-1, ANP, BNP, and TNF-alpha are all elevated in heart failure. Most of these factors correlate with the prognosis, but only a minor part seems to possess additional, independent information when other information that is normally available in such patients is taken into account. At present, the diagnosis of heart failure cannot be made on only one blood sample. However, neuroendocrine markers seem: 1) to have a role in the diagnosis and classification of heart failure, 2) to be useful in providing a "neuroendocrine profile", which elucidates different aspects of heart failure, and 3) to be of probable value in the choice and titration of medical treatment for the individual patient in the future.
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PMID:[Neuroendocrine activation in heart insufficiency II. Can diagnosis be confirmed and prognosis evaluated by a blood test?]. 1109 50

Whether alcohol-induced heart failure is caused by a direct toxic effect of ethanol, metabolites, or whether it is a secondary result of neurohumoral, hormonal, or nutritional factors is not clear. To address this question a Langendorff retrograde coronary perfusion model of rat heart was used to study the effect of 0.5% (v/v) ethanol (n = 7) and 0.5 mM acetaldehyde (n = 9) on left ventricular expression of ANP, BNP, p53, p21, TNF-alpha,bax, bcl-2 as well as on DNA-fragmentation. Ethanol infusion of 150 min duration significantly induced both ANP and p21 mRNA expression of ventricular myocardium compared with hearts infused with vehicle (n = 8). Acetaldehyde did not exert any significant effects on any of the parameters studied, although the mean expression of TNF-alpha tended to be lower in the acetaldehyde-treated hearts than in control hearts. No evidence of increased DNA-fragmentation was found in ethanol or acetaldehyde treated groups. We conclude that ethanol per se is capable of inducing genes associated with hypertrophy and impaired function of the heart whereas a significant apoptosis is not involved in the initial phase of alcohol-induced cardiac injury.
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PMID:Ethanol infusion increases ANP and p21 gene expression in isolated perfused rat heart. 1118 Oct 50

Beneficial cardiac effects of growth hormone (GH) have been shown in heart failure in several settings, but studies are lacking on this and other forms of treatment in the cardiomyopathic (CM) mouse heart. In mice with dilated cardiomyopathy due to disruption of the muscle LIM protein (MLP) gene [MLP null mice (MLP-/-)], natural history was first assessed by an initial echocardiogram at 8 weeks and a later follow-up study (n = 31). In most mice, left ventricular (LV) dilation increased and/or function decreased by 5 months, and 3 of 12 mice followed for 9 months died. At the end of follow-up, 22 MLP-/- mice (average age 10.2 months) had both LV dilation and reduced LV function and were selected for studies of GH effects on cardiac function and gene expression; mice were randomized to vehicle (controls) or recombinant human (rh) GH and restudied after 2 weeks. In the GH-treated group compared to the control group, LV % fractional shortening and LV wall thickness (echocardiography) were increased, the LV dP/dtmax (catheter-tip micromanometry) was enhanced, and LV relaxation (tau) improved; however, the LV weight was not significantly increased. The LV expression of many genes was altered in MLP-/- mice, and several were influenced by GH. Thus, short-term RhGH treatment improved LV function in a setting of chronic cardiac deterioration and significantly reduced elevated LV mRNA expression of some (ANP, BNP) but not other members of the embryonic gene program. The MLP null cardiomyopathic mouse can be useful for exploring altered signaling and therapeutic interventions in heart failure.
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PMID:Effects of growth hormone on cardiac dysfunction and gene expression in genetic murine dilated cardiomyopathy. 1119 63

B-type natriuretic peptide, a proteohormone secreted by the left ventricle in response to wall-tension, is a promising laboratory parameter for the detection and follow-up of heart failure. In this report analytical validation data of a non-isotopic point-of-care testing system for the quantitative determination of BNP (Triage BNP, Biosite, USA) are given. Despite a very short turn-around time of about 10 minutes the assay proved to be reproducible (interassay coefficient of variation (n=10) of 8.4% and 8.0% at concentrations of 19.3 ng/l and 392 ng/l, respectively), linear (r=0.998, from 5 ng/l to 818 ng/l), and rugged with respect to common interferents; compared to the widely used SHIONORIA BNP assay (CIS, France) higher results were found (Triage-BNP = 1.52 x SHIONORIA BNP - 7.0 ng/l; n=70) with a relatively close correlation of the results (r=0.935). It is concluded that the Triage BNP assay meets the analytical requirements for further clinical validation and may allow a more widespread clinical use of BNP determination in contrast to competing assays with long turn-around times.
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PMID:B-type natriuretic peptide (BNP)--validation of an immediate response assay. 1121 20

Atrial myocytes synthesise atrial natriuretic factor prohormone consisting of 126 amino acids (ANP1-126) which is subsequently processed to several fragments. Atrial natriuretic factor (ANF, ANP99-126) originating from the C-terminal portion of prohormone is a best described atrial peptide. However, several peptides originating from the N-terminus of this precursor also circulate and produce significant diuresis, natriuresis and vasodilatation. These are: long acting natriuretic peptide (ANP1-30), vessel dilator (ANP31-67) and kaliuretic peptide (ANP79-98). ANP1-98 and ANP68-98 also circulate. Kaliuretic peptide specifically stimulates urinary potassium excretion. These peptides are slowly metabolised and their plasma concentration is higher than ANF suggesting their important role in water-electrolyte homeostasis and regulation of vascular tone. N-terminal atrial peptides don't bind to classical natriuretic peptide receptors, each of them has probably its own unique receptors. Although these peptides activate particulate guanylate cyclase in a number of tissues, some of their effects, for example natriuresis, are not mediated by cGMP but rather by prostaglandin E2. Plasma concentration of N-terminal atrial peptides may be useful in diagnosis and risk stratification in patients with heart failure and after myocardial infarction. Recently N-terminal fragment of brain natriuretic peptide (BNP1-76) was identified in the blood. This peptide is secreted together with its C-terminal partner, BNP77-108 by ventricular myocytes. Some studies suggest that N-terminal BNP may be also a useful diagnostic tool in cardiovascular diseases.
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PMID:[N-terminal atrial natriuretic peptides]. 1122 84

This study assessed the prognostic value of Iodine-123-metaiodobenzylguanidine (MIBG) imaging and of the plasma level of cardiac natriuretic peptides in patients with left ventricular dysfunction resulting from cardiomyopathy. Predictors of cardiac death or hospitalization related to progressive heart failure were examined in 171 patients with chronic heart failure (96 patients with idiopathic cardiomyopathy and 75 patients with ischemic cardiomyopathy). All patients underwent MIBG imaging at rest and other hemodynamic studies. During a mean (+/-SD) follow-up period of 27+/-11 months, 11 patients died from heart failure and 16 required hospitalization. High MIBG washout was an independent predictor of cardiac death (relative risk [RR] = 1.158, p<0.0001) whereas the plasma level of brain natriuretic peptide (BNP: relative risk [RR] = 1.005, p<0.0001) and high MIBG washout (relative risk [RR] = 1.094, p<0.0001) were predictors of progressive heart failure (ie, combined cardiac death and hospitalization). Accelerated myocardial adrenergic nerve activity as assessed by MIBG imaging and the plasma levels of BNP are powerful predictors of the patient's prognosis.
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PMID:Prognostic value of iodine-123-metaiodobenzylguanidine imaging and cardiac natriuretic peptide levels in patients with left ventricular dysfunction resulting from cardiomyopathy. 1126 87

Endothelin (ET)-1 is a potent vasoconstrictor peptide produced in the myocardium that can exert important effects on cardiac myocyte growth and phenotype; cardiac natriuretic peptides (ANP and BNP) are known to act as physiological antagonists of ET-1. In this study a comparative determination of ET-1 receptors and of the local productions of ET-1 and of ANP and BNP was made in different sites of failing and nonfailing hearts. Tissue from right and left atrium, right and left ventricle and interventricular septum from seven adult heart transplant recipients with end-stage idiopathic dilated cardiomyopathy (functional class III and IV, with ejection fraction < 35%) and from four postmortem subjects without cardiac complications was analyzed. In failing hearts we observed a tendency to increase of density of binding sites, most evident in left ventricle (62.6+/-22.6 fmol/mg protein vs. 29.0+/-3.3, mean +/- SEM, p = ns). A prevalence of ET-A subclass, observed in all samples, resulted more pronounced in failing hearts where this increase, found in all the cardiac regions, was more evident in left ventricle (p = 0.0007 vs nonfailing hearts). The local concentrations of ET-1, ANP and BNP resulted significantly increased in failing hearts with respect to controls in all sides of the heart. In failing hearts we have observed a tendency to increase in endothelin receptor density mainly due to a significant upregulation of ET-A subtype and a parallel increase of the tissue levels of ANP, BNP and ET-1 indicating an activation of these systems in heart failure.
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PMID:Endothelin-1, endothelin-1 receptors and cardiac natriuretic peptides in failing human heart. 1140 Sep 14

This study was aimed at the mechanism of the circulatory failure characteristic of the elderly through elucidating the cause of leg edema frequently found in patients under treatment in health care facilities for physical or mental handicaps. ECG and measurement of atrial (ANP) and brain (BNP) natriuretic peptides were carried out on 156 patients (mostly females aged 84 years on average) and echocardiographic assessment was done on 44 patients. Non-specific ST-T abnormalities were frequently found in patients with moderate or severe leg edema (61 vs. 37% in those with slight or no edema). BNP levels were markedly increased in patients with either leg edema or ECG abnormalities (Group B) and with both (Group C) compared with those without either (Group A), with averages of 35.5+/-23.9, 91.3+/-80.1, and 184.3+/-139.0 pg/ml, respectively, for Group A, B, and C. UCG examination revealed marked regurgitation of cardiac valves, more frequently in patients with BNP over 50 pg/ml than in those with less (14/24 vs. 2/20), with a difference in extent of 5.7 versus 1.6 on an arbitrary scale. In addition to left ventricular hypertrophy, dilatation of the left atrium and inferior vena cava was frequently observed in patients with higher BNP levels. It is concluded that both cardiac valve regurgitation and myocardial damage represented by ST-T abnormalities on ECG result in heart failure characteristic of the elderly, and that an increase in BNP is an important sign of such heart failure.
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PMID:Leg edema, ST-T abnormalities, and high BNP values are important signs of heart failure in the elderly. 1146 20

Cardiac natriuretic peptide hormones (ANP and BNP) are synthesized and secreted by the heart, producing several biological effects, such as natriuresis, vasorelaxation, hypotension, and neuromodulation. Extensive studies conducted in both animals and humans have documented that cardiac natriuretic peptides (CNPs) are secreted into the circulatory system via the coronary sinus into the right atrium, and then rapidly degraded and removed from the blood by plasma proteases and specific clearance receptors. Usually, studies of CNPs kinetics have been carried out following an experimental protocol in which labeled or unlabeled hormone is administered (by constant infusion or bolus injection) and the corresponding concentration of the hormone is measured in peripheral venous blood. However, when a uniform intravascular concentration throughout artero-venous vessels is lacking due to the very rapid clearance of the substance being studied (such as CNPs), the classical compartmental or none compartmental approach may not be suitable for interpreting the experimental data. In this case, a more physiological circulatory model, which does not assume a uniform intravascular distribution of the hormone and comprises several anatomo-functional blocks arranged in a series and supplied by the same flow (cardiac output) should be adopted. Different experimental designs (infusion or bolus injection) as well as multiple sampling sites (aorta and pulmonary artery, inferior vena cava, femoral vein) were used in ANP kinetic studies. Using a circulatory approach, ANP has been demonstrated to be rapidly distributed and degraded; in healthy subjects about 50% of ANP secreted into the right atrium is extracted by the peripheral tissues during the first pass throughout the body. Since CNPs have important fluid-volume regulatory features, it has been postulated that they also play a key role in volume homeostasis in several pathophysiological states, such as congestive heart failure. Indeed, a markedly altered degradation and distribution of ANP in patients with cardiac failure who show a resistance to its natriuretic effects, even in those on the early stage of clinical disease, whose CNPs plasma levels are in the normal range, have been demonstrated. Recent studies indicate that some drugs, by inhibiting the degradation of CNPs by plasma proteases and can thus affect CNP kinetics, may be useful in the treatment of arterial hypertension and cardiac failure.
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PMID:Turnover studies on cardiac natriuretic peptides: methodological, pathophysiological and therapeutical considerations. 1146 82


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