Elsevier

JACC: Heart Failure

Volume 7, Issue 10, October 2019, Pages 891-898
JACC: Heart Failure

Clinical Research
Differential Regulation of ANP and BNP in Acute Decompensated Heart Failure: Deficiency of ANP

https://doi.org/10.1016/j.jchf.2019.05.012Get rights and content
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Abstract

Objectives

This study investigated the differential regulation of circulating atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with acute decompensated heart failure (ADHF) and tested the hypothesis that a relative deficiency of ANP exists in a subgroup of patients with ADHF.

Background

The endocrine heart releases the cardiac hormones ANP and BNP, which play a key role in cardiovascular (CV), renal, and metabolic homeostasis. In heart failure (HF), both plasma ANP and BNP are increased as a compensatory homeostatic response to myocardial overload.

Methods

ANP and BNP concentrations were measured in a small group of patients with ADHF (n = 112). To support this study’s goal, a total of 129 healthy subjects were prospectively recruited to establish contemporary normal values for ANP and BNP. Plasma 3′,5′cyclic guanosine monophosphate (cGMP), ejection fraction (EF), and body mass index (BMI) were measured in these subjects.

Results

In cases of ADHF, 74% of patients showed elevated ANP and BNP. Importantly, 26% of patients were characterized as having normal ANP (21% of this subgroup had normal ANP and elevated BNP). Cyclic GMP was lowest in the ADHF group with normal levels of ANP (p < 0.001), whereas BMI and EF were inversely related to ANP levels (p = 0.003).

Conclusions

Among a subgroup of patients hospitalized with ADHF, the presence of an ANP deficiency is consistent with a differential regulation of ANP and BNP and suggests the existence of a potentially compromised compensatory cardiac endocrine response. These findings have implications for the pathophysiology, diagnostics, and therapeutics of human HF.

Key Words

acute decompensated heart failure
atrial natriuretic peptide deficiency
atrial natriuretic peptide
natriuretic peptide

Abbreviations and Acronyms

ADHF
acute decompensated heart failure
ANP
atrial natriuretic peptide
BMI
body mass index
BNP
B-type natriuretic peptide
cGMP
3′,5′cyclic guanosine monophosphate
EF
ejection fraction
eGFR
estimated glomerular filtration rate
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
NP
natriuretic peptide
pGC-A
particulate guanylyl cyclase A receptor

Cited by (0)

Supported by National Heart, Lung and Blood Institute grants R01 HL36634 and RO1 HL13688 to Dr. Burnett and by the Mayo Foundation. Dr. Burnett holds equity in a patent licensed to Zumbro Discovery; and is consultant to Novartis and Ironwood. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.