scholarly journals Prolonged effects of B-type natriuretic peptide infusion on cardiac remodeling after sustained myocardial injury

2009 ◽  
Vol 297 (2) ◽  
pp. H708-H717 ◽  
Author(s):  
Isaac George ◽  
Brad Morrow ◽  
Kai Xu ◽  
Geng-Hua Yi ◽  
Jeffrey Holmes ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Myocardial Injury ◽  
Acute Decompensated Heart Failure ◽  
Systolic Function ◽  
Ischemic Injury ◽  
Decompensated Heart Failure ◽  
Canine Model ◽  
Left Ventricular ◽  
Saline Control ◽  
Coronary Embolization

B-type natriuretic peptide (BNP) is an established first-line therapy for acute decompensated heart failure (HF), but its efficacy in preventing left ventricular (LV) remodeling after myocardial injury is unknown. The goal of this study was to evaluate the effects of BNP therapy on remodeling after ischemic injury in an awake canine model. Dogs were chronically instrumented for hemodynamics. Ischemia was created by daily coronary embolization (Embo; 3.1 × 104 beads/day) for 3 wk; 60 min after the first embolization, BNP (100 ng·kg−1·min−1; n = 6) or saline (control; n = 6) was continuously infused via a left atrial catheter for 3 wk. Hemodynamics and echocardiography were performed in an awake state at baseline, 3 wk after Embo + BNP infusion, and 4 wk after stopping Embo + BNP infusion. End-systolic elastance (Ees) and LV change in pressure over time (dP/d t) were preserved throughout Embo + BNP therapy versus control therapy (Ees: 3.76 ± 1.01 vs. 1.41 ± 0.16 mmHg/ml; LV dP/d t: 2,417 ± 96 vs. 2,068 ± 95 mmHg/s; both P < 0.05 vs. control). LV end-diastolic dimension was significantly smaller in BNP-treated dogs compared with control dogs (4.29 ± 0.10 vs. 4.77 ± 0.17 cm), and ejection fraction was maintained in treated dogs vs. control dogs (53 ± 1% vs. 46 ± 2%) (both P < 0.05 vs. control). Cyclooxygenase (COX)-2 expression in terminal LV tissue was significantly reduced after BNP therapy. Treatment with continuous infusion of BNP preserved LV geometry, improved systolic function, and prevented the progression of systolic HF after persistent ischemic injury.

Comparison of the Effects of Levosimendan Dobutamine and Vasodilator Therapy on Ongoing Myocardial Injury in Acute Decompensated Heart Failure

2016 ◽  
Vol 22 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Erkan Gencer ◽  
Volkan Doğan ◽  
Müjgan Tek Öztürk ◽  
Aydın Nadir ◽  
Ahmet Musmul ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Injury ◽  
Cell Damage ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Short Term ◽  
Ventricular Ejection Fraction

Background: Cardiac troponins (cTn) are reliable and the most sensitive biomarker in the setting of acute decompensated heart failure (ADHF). Acute decompensated heart failure is usually associated with worsening chronic heart failure, and it may be caused by ongoing minor myocardial cell damage that may occur without any reported precipitating factors. Methods: We compared the short-term effect of levosimendan (LEV), dobutamine (DOB), and vasodilator treatment (nitroglycerin [NTG]) on myocardial injury with hemodynamic, neurohumoral, and inflammatory indicators. One hundred twenty-two patients with a mean age of 66 ± 9 years were treated with LEV (n = 40), DOB (n = 42), and NTG (n = 40) and examined retrospectively. Blood samples (cTnI, N-terminal probrain natriuretic peptide [NT-proBNP], highly sensitive C-reactive protein [HsCRP], and others), left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (sPAP), and 6-minute walk distance (6MWD) were compared before and after treatment. Results: At admission, detectable levels of cTnI were observed in 53% of patients (≥0.05 ng/mL). Serial changes in the mean cTnI levels were not significantly different between the groups (LEV 0.04 ± 0.01 to 0.03 ± 0.01 ng/mL; DOB 0.145 ± 0.08 to 0.08 ± 0.03 ng/mL; NTG 0.1 ± 0.03 to 0.09 ± 0.02 ng/mL; overall P = .859). Favourable effects on the NT-proBNP, sPAP values, LVEF, 6MWD, and HsCRP were observed overall, especially in the LEV groups. Conclusion: Beneficial effects of short-term use of LEV, DOB, and NTG on ongoing myocardial injury were demonstrated. These findings can be attributed to the anti-ischemic properties as well as the hemodynamic, neurohumoral, and functional benefits from the positive inotropes, especially LEV, in patients with ADHF.

scholarly journals Superiority of proatrial natriuretic peptide in the prognostic power in patients with acute decompensated heart failure on hospital admission: comparison with B-type natriuretic peptide and other natriuretic peptide forms

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001072
Author(s):  
Seiji Takashio ◽  
Hiroyuki Takahama ◽  
Toshio Nishikimi ◽  
Tomohiro Hayashi ◽  
Chiaki Nagai-Okatani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Events ◽  
Hospital Admission ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Molecular Forms ◽  
Lv Function ◽  
Prognostic Power

AimsThere are significant differences in how atrial (A-type) and B-type natriuretic peptide (ANP and BNP) are secreted and metabolised, but there is little information available about the relative clinical significance of the two peptides. The aim of the present study was to investigate: (1) the association between the circulating level of each ANP molecular form and patient clinical background and (2) their prognostic power for patients with acute decompensated heart failure (ADHF).MethodsWe used specific chemiluminescence enzyme immunoassays to prospectively evaluate the levels of six bioactive molecular forms of ANP (pro-ANP, β-ANP and total ANP) and BNP (pro-BNP, N-terminal pro-BNP (NT-pro-BNP) and total BNP) in plasma samples collected from 173 patients with ADHF on their hospital admission.ResultsWe found that pro-ANP levels were strongly associated with left ventricular (LV) size and ejection fraction (p<0.001), but were not associated with left atrial size. Percent pro-ANP ([pro-ANP/total ANP]x100) was also associated with LV size and function. During the follow-up term (median: 469 days), composite adverse events (all causes of death or rehospitalisation for HF) occurred in 67 patients (38.7 %). Pro-ANP was significantly associated with composite adverse events even after adjusting by estimated glomerular filtration rate (eGFR) (p<0.05). In contrast, NT-pro-BNP was not independent of eGFR in the multivariate analysis.ConclusionCirculating levels of pro-ANP are strongly associated with LV function and clinical outcomes of patients with ADHF. These findings suggest that during the acute phases of HF, pro-ANP has a prognostic power comparable with NT-pro-BNP independently of renal function.

scholarly journals Rapid Fire Abstract session: assessment of systolic function: clinical perspectives and future directions782How the echocardiographic parameters of left ventricular function change during the first year after myocardial infarction when the ejection fraction remains normal?783Blunted increase in LV longitudinal deformation during exercise contributes to the transition from an asymptomatic stage to clinically overt HFpEF784A septal flash induced by right ventricular pacing is associated with left ventricular dysfunction and remodeling785Assessment of right ventricular systolic function in patients with significant functional tricuspid regurgitation: longitudinal parameters increase accuracy and predict cardiovascular outcomes786Effect of left ventricular augmentation with alginate biopolymer on right heart function787Left ventricular mechanics: novel tools to evaluate function and dyssynchrony in controls and cardiac resynchronization therapy candidates788How does regional wall thickness influence strain measurements?789TAPSE-estimated right ventricular systolic dysfunction predicts mortality among acute decompensated heart failure with preserved ejection fraction patients: a prospective study in a secondary center

2015 ◽  
Vol 16 (suppl 2) ◽  
pp. S130-S132 ◽  
Author(s):  
T Baron ◽  
W Kosmala ◽  
S I Sarvari ◽  
A Garcia Martin ◽  
S I Dumitrescu ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Acute Decompensated Heart Failure ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Mechanics ◽  
Functional Tricuspid Regurgitation

Cardiac diastolic dysfunction in conscious dogs with heart failure induced by chronic coronary microembolization

2006 ◽  
Vol 291 (6) ◽  
pp. H3154-H3158 ◽  
Author(s):  
Robert M. Gill ◽  
Bonita D. Jones ◽  
Angela K. Corbly ◽  
Juan Wang ◽  
Julian C. Braz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Diastolic Pressure ◽  
Systolic Function ◽  
Canine Model ◽  
Left Ventricular ◽  
Plasminogen Activator Inhibitor 1 ◽  
Stiffness Constant ◽  
Coronary Embolization ◽  
Pai 1

Left ventricular (LV) diastolic dysfunction is a fundamental impairment in congestive heart failure (CHF). This study examined LV diastolic function in the canine model of CHF induced by chronic coronary embolization (CCE). Dogs were implanted with coronary catheters (both left anterior descending and circumflex arteries) for CCE and instrumented for measurement of LV pressure and dimension. Heart failure was elicited by daily intracoronary injections of microspheres (1.2 million, 90- to 120-μm diameter) for 24 ± 4 days, resulting in significant depression of cardiac systolic function. After CCE, LV maximum negative change of pressure with time (dP/d tmin) decreased by 25 ± 2% ( P < 0.05) and LV isovolumic relaxation constant and duration increased by 19 ± 5% and 25 ± 6%, respectively (both P < 0.05), indicating an impairment of LV active relaxation, which was cardiac preload independent. LV passive viscoelastic properties were evaluated from the LV end-diastolic pressure (EDP)-volume (EDV) relationship (EDP = beα*EDV) during brief inferior vena caval occlusion and acute volume loading, while the chamber stiffness coefficient (α) increased by 62 ± 10% ( P < 0.05) and the stiffness constant ( k) increased by 66 ± 13% after CCE. The regional myocardial diastolic stiffness in LV anterior and posterior walls was increased by 70 ± 25% and 63 ± 24% (both P < 0.05), respectively, after CCE, associated with marked fibrosis, increase in collagen I and III, and enhancement of plasminogen activator inhibitor-1 (PAI-1) protein expression. Thus along with depressed LV systolic function there is significant impairment of LV diastolic relaxation and increase in chamber stiffness, with development of myocardial fibrosis and activation of PAI-1, in the canine model of CHF induced by CCE.

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