TY - JOUR
T1 - Ratio of pro-B-type natriuretic peptide (BNP) to total BNP is decreased in mild, but not severe, acute decompensated heart failure patients
T2 - A novel compensatory mechanism for acute heart failure
AU - Takahama, Hiroyuki
AU - Takashio, Seiji
AU - Nishikimi, Toshio
AU - Hayashi, Tomohiro
AU - Nagai-Okatani, Chiaki
AU - Nakagawa, Yasuaki
AU - Amaki, Makoto
AU - Ohara, Takahiro
AU - Hasegawa, Takuya
AU - Sugano, Yasuo
AU - Kanzaki, Hideaki
AU - Yasuda, Satoshi
AU - Kangawa, Kenji
AU - Minamino, Naoto
AU - Anzai, Toshihisa
N1 - Funding Information:
This work was partly supported by the Intramural Research Fund of the National Cerebral and Cardiovascular Center of Japan (grants 22-1-4 and 27-1-5 to N.M.).
Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: A recent study showed that both glycosylation of pro-B-type natriuretic peptide (BNP) and the proBNP/total BNP ratio are decreased in acute decompensated heart failure (ADHF). However, the following points regarding the proBNP/total BNP ratio have not been determined in patients with ADHF: 1) the relationship with the severity of ADHF, 2) the changes in the ratio during treatment, and 3) the relationship with cyclic guanosine monophosphate (cGMP)-generating activity. Methods: Plasma proBNP and total BNP (proBNP + mature BNP) were measured in patients with ADHF (n = 154). Measurement was performed on admission, 3 and 7 days after admission, and before discharge using recently developed sandwich chemiluminescence enzyme immunoassays. The percent proBNP was calculated as: (proBNP/total BNP) × 100. Results: On admission, %proBNP was higher in patients with severe ADHF than in patients with mild ADHF (median: 61.7% vs. 56.2%, respectively; p < 0.01), while the plasma cGMP/total BNP ratio, an index of the biological activity of BNP, was lower (p < 0.001). In patients with severe ADHF, the higher %proBNP and lower cGMP/total BNP ratio were unchanged during hospitalization, whereas %proBNP increased gradually in patients with mild ADHF and the cGMP/total BNP ratio also increased at 3 days after admission. Conclusion: These findings suggest that in patients with mild ADHF, compensation for heart failure occurs via increased proBNP processing, leading to increase of mature BNP and activation of the BNP/cGMP cascade. In contrast, this compensatory mechanism may be impaired in patients with severe ADHF and a vicious cycle can potentially occur.
AB - Background: A recent study showed that both glycosylation of pro-B-type natriuretic peptide (BNP) and the proBNP/total BNP ratio are decreased in acute decompensated heart failure (ADHF). However, the following points regarding the proBNP/total BNP ratio have not been determined in patients with ADHF: 1) the relationship with the severity of ADHF, 2) the changes in the ratio during treatment, and 3) the relationship with cyclic guanosine monophosphate (cGMP)-generating activity. Methods: Plasma proBNP and total BNP (proBNP + mature BNP) were measured in patients with ADHF (n = 154). Measurement was performed on admission, 3 and 7 days after admission, and before discharge using recently developed sandwich chemiluminescence enzyme immunoassays. The percent proBNP was calculated as: (proBNP/total BNP) × 100. Results: On admission, %proBNP was higher in patients with severe ADHF than in patients with mild ADHF (median: 61.7% vs. 56.2%, respectively; p < 0.01), while the plasma cGMP/total BNP ratio, an index of the biological activity of BNP, was lower (p < 0.001). In patients with severe ADHF, the higher %proBNP and lower cGMP/total BNP ratio were unchanged during hospitalization, whereas %proBNP increased gradually in patients with mild ADHF and the cGMP/total BNP ratio also increased at 3 days after admission. Conclusion: These findings suggest that in patients with mild ADHF, compensation for heart failure occurs via increased proBNP processing, leading to increase of mature BNP and activation of the BNP/cGMP cascade. In contrast, this compensatory mechanism may be impaired in patients with severe ADHF and a vicious cycle can potentially occur.
KW - Acute heart failure
KW - B-type natriuretic peptide
KW - Cardiac remodeling
KW - Cyclic guanosine monophosphate
KW - Pro-B-type natriuretic peptide
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U2 - 10.1016/j.ijcard.2017.12.047
DO - 10.1016/j.ijcard.2017.12.047
M3 - Article
C2 - 29544926
AN - SCOPUS:85043454762
VL - 258
SP - 165
EP - 171
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -