Role Of Brain Natriuretic Peptide Research Articles

HEMODYNAMIC PARAMETERS AND STRUCTURAL CHANGES OF THE MYOCARDIUM IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION: THE ROLE OF BRAIN NATRIURETIC PEPTIDE, NT-PRO BNP, GALECTIN-3 AND sST-2

Heart failure remains one of the most common causes of hospitalization, disability, and mortality in the working population in the world, particularly in Ukraine; it has a high prevalence, an unfavorable prognostic course, and also causes significant economic costs. The prevalence of heart failure (HF) in the general population is 1.5 - 2.0%, and among people over 65 years old - 6 - 10% [10]. The main etiological cause of the development of chronic heart failure (CHF) is coronary heart disease (CHD), which is confirmed by the data of multicenter studies. One of the features of CHF is the high heterogeneity of its clinical manifestations and the absence of absolutely pathognomonic symptoms, which often leads to late diagnosis and deterioration of the prognosis of the course of the disease [1-6]. In the last decade, biomarkers for the diagnosis and prognosis of HF have been actively researched in search of the "ideal" one that can characterize the activation of all links of the HF syndrome and provide additional information about natriuretic peptides (NAUP). Given the extremely complex and multifaceted biochemical interactions that underlie the pathophysiology of CHF, scientists are paying more attention to a multimarker strategy for the diagnosis and risk stratification of CHF.Aim. The purpose of the paper is to investigate the role of brain natriuretic peptide (BNP), NT-pro BNP, galectin-3, s-ST2 in the development of heart failure in patients with atrial fibrillation.Material and methods. 468 patients aged 45-65 years (54,3±7,2 years) and 56 healthy people were included in the study. Among the examined were 234 (50,0%) women and 234 (50,0%) men. Group I – control, 56 practically healthy individuals; Group II - patients with CHF without AF (n=234); III group - patients with CHF and AF (n=234).Diagnoses of AF and HF were carried out according to the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure, confirmed by the order of the Ministry of Health of Ukraine №436 of 07.03.2006. and according to the 2021 Recommendations of the European Society of Cardiology (ESC) on the diagnosis and treatment of acute and chronic heart failure. In addition to the general clinical examination, an enzyme immunoassay was also performed to determine the content of brain natriuretic peptide, NT-pro BNP, galectin-3 and sST-2 in the blood.Results. The analysis of structural changes of the myocardium in various phenotypes of CHF revealed a probable increase in the transverse size of the left atrium by 18,5%, the index of the size of the left atrium by 25,4%, the area of the left atrium by 25,3%, the volume of the left atrium by 21,6% and left atrial volume index by 10,1% in patients with CHF and concomitant AF.The study founds a probable increase in the levels of NT-pro BNP (by 50,1%; p<0,05) and brain natriuretic peptide (by 47,3%; p<0,05) in patients with AF and CHF. With an increase in the size of the left atrium against the background of CHF and AF, a probable increase in the concentration of galectin-3 (by 24.3%, p<0.05) and a probable increase in the level of sST-2 (by 41.4%, p<0, 05) were set. It has been proven that an important aspect of the phenotype of CHF with accompanying AF is the enlargement of the left atrium (LA), which probably correlates with the content of brain natriuretic peptide (BNP) (r=0,35; p<0,05), as well as with sST-2 content (r=0,41; p<0,05).

Investigating the Role of Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Thrombosis and Acute Ischemic Stroke Etiology.

The need for biomarkers for acute ischemic stroke (AIS) to understand the mechanisms implicated in pathological clot formation is critical. The levels of the brain natriuretic peptides known as brain natriuretic peptide (BNP) and NT-proBNP have been shown to be increased in patients suffering from heart failure and other heart conditions. We measured their expression in AIS clots of cardioembolic (CE) and large artery atherosclerosis (LAA) etiology, evaluating their location inside the clots, aiming to uncover their possible role in thrombosis. We analyzed 80 thrombi from 80 AIS patients in the RESTORE registry of AIS clots, 40 of which were of CE and 40 of LAA etiology. The localization of BNP and NT-BNP, quantified using immunohistochemistry and immunofluorescence, in AIS-associated white blood cell subtypes was also investigated. We found a statistically significant positive correlation between BNP and NT-proBNP expression levels (Spearman's rho = 0.668 p < 0.0001 *). We did not observe any statistically significant difference between LAA and CE clots in BNP expression (0.66 [0.13-3.54]% vs. 0.53 [0.14-3.07]%, p = 0.923) or in NT-proBNP expression (0.29 [0.11-0.58]% vs. 0.18 [0.05-0.51]%, p = 0.119), although there was a trend of higher NT-proBNP expression in the LAA clots. It was noticeable that BNP was distributed throughout the thrombus and especially within platelet-rich regions. However, NT-proBNP colocalized with neutrophils, macrophages, and T-lymphocytes, suggesting its association with the thrombo-inflammatory process.

Role of brain natriuretic peptide as an indicator for reverse remodeling of left ventricular systolic dysfunction after introduction of sacubitril / valsartan in patients with heart failure with reduced ejection fraction

Role of brain natriuretic peptide as an indicator for reverse remodeling of left ventricular systolic dysfunction after introduction of sacubitril / valsartan in patients with heart failure with reduced ejection fraction

Biomarkers and their combination in a prediction of decompensation after an index hospitalization for acute heart failure.

Heart failure (HF) still remains as one of the most common causes of hospital admission with a high mortality rate. To investigate the possible prognostic role of brain natriuretic peptide (BNP), high-sensitivity (hs) cardiac troponin (cTn) I, cystatin C, and cancer antigen 125 (CA125) in the prediction of decompensation after an index hospitalization and to investigate their possible additive prognostic value. Two hundred twenty-two patients hospitalized with acute HF were monitored and followed for 18 months. BNP at discharge has the highest sensitivity and specificity in the prediction of decompensation. For a cutoff value of 423.3 pg/ml, sensitivity was 64.3% and specificity was 64.5%, with a positive predictive value of 71.6% and an area under the curve (AUC) of 0.69 (P < 0.001). The hazard risk (HR) for decompensation when the discharge BNP was above the cutoff value was 2.18. Cystatin C, at a cutoff value of 1.46 mg/L, had a sensitivity of 57% and specificity of 57.8%, with a positive predictive value of 65.8% and an AUC of 0.59 (P = 0.028). CA125, in the prediction of decompensation in patients with acute heart failure (AHF) and at a cutoff value of 80.5 IU/L, had a sensitivity of 60.5% and specificity of 53.3%, with a positive predictive value of 64.5% and an AUC of 0.59 (P = 0.022). The time till onset of decompensation was significantly shorter in patients with four versus three elevated biomarkers (P = 0.047), with five versus three elevated biomarkers (P = 0.026), and in patients with four versus two elevated biomarkers (P = 0.026). The HR for decompensation in patients with five positive biomarkers was 3.7 (P = 0.001) and in patients with four positive biomarkers was 2.5 (P = 0.014), compared to patients who had fewer positive biomarkers. BNP, cystatin C, and CA125 are predictors of decompensation, and their combined usage leads to better prediction of new decompensation.

Prognostic value of soluble ST2, high-sensitivity cardiac troponin, and NT-proBNP in type 2 diabetes: a 15-year retrospective study

BackgroundPatients with type 2 diabetes (T2DM) present an increased risk of cardiovascular (CV) disease and excess CV-related mortality. Beyond the established role of brain natriuretic peptide (BNP) and cardiac troponins (cTn), other non-cardiac-specific biomarkers are emerging as predictors of CV outcomes in T2DM.MethodsSerum levels of soluble suppression of tumorigenesis 2 (sST2), high-sensitivity (hs)-cTnI, and N-terminal (NT)-proBNP were assessed in 568 patients with T2DM and 115 healthy controls (CTR). Their association with all-cause mortality and the development of diabetic complications was tested in T2DM patients over a median follow-up of 16.8 years using Cox models and logistic regressions.ResultssST2 followed an increasing trend from CTR to uncomplicated T2DM patients (T2DM-NC) to patients with at least one complication (T2DM-C), while hs-cTnI was significantly higher in T2DM-C compared to CTR but not to T2DM-NC. A graded association was found between sST2 (HR 2.76 [95% CI 1.20–6.33] for ≥ 32.0 ng/mL and 2.00 [1.02–3.94] for 16.5–32.0 ng/mL compared to < 16.5 ng/mL, C-statistic = 0.729), NT-proBNP (HR 2.04 [1.90–4.55] for ≥ 337 ng/L and 1.48 [1.05–2.10] for 89–337 ng/L compared to < 89 ng/L, C-statistic = 0.741), and 15-year mortality in T2DM, whereas increased mortality was observed in patients with hs-cTnI ≥ 7.8 ng/L (HR 1.63 [1.01–2.62]). A ‘cardiac score’ based on the combination of sST2, hs-cTnI, and NT-proBNP was significantly associated with all-cause mortality (HR 1.35 [1.19–1.53], C-statistic = 0.739) and development of CV events.ConclusionssST2, hs-cTnI, and NT-proBNP are associated with 15-year mortality and onset of CV events in T2DM. The long-term prognostic value of sST2 and its ability to track variables related to insulin resistance and associated metabolic disorders support its implementation into routine clinical practice.

The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial

BackgroundCatheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF).MethodsThe SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation.ResultsOf the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00).ConclusionWe conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies.Trial registration: NCT00438113, registered February 21, 2007.

Role of Brain Natriuretic Peptide in the Prediction of Early Postoperative Seizures Following Surgery for Traumatic Acute Subdural Hematoma: A Prospective Study.

IntroductionBrain natriuretic peptide (BNP) is a reliable biomarker in the acute phase of traumatic brain injury. However, the relationship between BNP and traumatic acute subdural hematoma (aSDH) has not yet been addressed. This study aimed to analyze BNP levels on admission in surgically treated patients and assess their relationship with early postoperative seizures (EPS) and functional outcomes.MethodsPatients with unilateral traumatic aSDH who were surgically treated in our department between July 2017 and May 2020 were included in the study. BNP was preoperatively measured. Patients’ neurologic condition, radiographic variables on initial cranial computed tomography, sodium serum levels on admission, and occurrence of EPS were prospectively assessed. Functional outcome was assessed using the modified Rankin Scale (mRS) at discharge and follow-up (at 2–3 months). A poor outcome was defined by a mRS score > 3.ResultsEPS occurred in 20 (19.6%) of 102 surgically treated patients in the final cohort on the median day 3. A significant association between EPS and a poor Glasgow Coma Scale score at the 7th postoperative day was found, which in turn independently predicted a poor functional outcome at discharge and follow-up. Nonetheless, EPS were not associated with poor functional outcomes. The multivariate analysis revealed BNP > 95.4 pg/ml (aOR = 5.7, p = 0.003), sodium < 137.5 mmol/l (aOR = 4.6, p = 0.009), and left-sided aSDH (aOR = 4.4, p = 0.020) as independent predictors of EPS.ConclusionIn the early postoperative phase of traumatic aSDH, EPS were associated with worse neurologic conditions, which in turn independently predicted poor outcomes at discharge and follow-up. Although several EPS risk factors have already been elucidated, this study presents BNP as a novel reliable predictor of EPS. Further larger studies are needed to determine whether a more precise estimate of EPS risk using BNP levels can be reached.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-021-00269-w.

Role of brain natriuretic peptide in the prediction of long-term surgical outcome of chronic subdural hematoma

ObjectiveTo investigate the role of brain natriuretic peptide (BNP) in predicting long-term functional outcome and develop a new predictive score of poor functional outcome after surgery for chronic subdural hematoma (cSDH). MethodsPatients with cSDH that were surgically treated in our department between November 2016 and December 2019 were included in the study. Pre- and postoperative plasma BNP and clinical condition were prospectively recorded. At follow-up (5–6 months), a simplified modified Rankin Scale (mRS) questionnaire was conducted through a standardized telephone interview. A poor outcome was defined by a mRS > 3. Based on predictors of the long-term functional outcome, a score was calculated. Its accuracy was tested using the area under the curve (AUC) of the receiver operating characteristic analysis. ResultsIn total, 119 patients were analyzed (median age: 76 years, range: 44–94 years). Preoperative plasma BNP (BNP-1) was elevated in 77 patients (64.7%). For the follow-up phone interview, 101 patients (84.8%) were available. In the multivariate analysis, poor outcome at follow-up could be predicted using BNP-1 (p = 0.034), age (p = 0.036), motor deficit (p = 0.013) and Glasgow coma scale score on admission (p = 0.008). The “Functional Long-term Outcome Predictive score” (FLOP-score) was therefore computed, and revealed an excellent discriminative capacity compared to other scores, with an AUC of 0.86 (0.77–0.95). ConclusionsPreoperative plasma BNP is an independent predictor of functional outcome at follow-up. Using the FLOP-score, the risk of experiencing a poor outcome could accurately be predicted.

The Role of Brain Natriuretic Peptide as a Prognostic Marker for Sepsis.

Brain natriuretic peptide (BNP) is a neurohormone released in response to volume expansion and increased pressure. It is commonly used to assist in the diagnosis and management of heart failure. BNP can also play an important role as a biomarker in septic shock; however, elevations of BNP in conditions other than sepsis or cardiac dysfunction limits its use as the sole prognostic marker in patients hospitalized with sepsis. Further relationships regarding laboratory value and correlation with severity of illness need to be established with larger prospective studies to develop consensus regarding a cut-off point for optimum sensitivity and specificity in predicting in-hospital mortality related to sepsis.

Prognostic role of brain natriuretic peptide in children of the first year of life with congenital heart defects: a prospective cohort study

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation &gt; 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Prognostic role of brain natriuretic peptide in children of the first year of life with congenital heart defects: a prospective cohort study

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation &gt; 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Prognostic role of brain natriuretic peptide in children of the first year of life with congenital heart defects: a prospective cohort study

Background. Congenital heart defects (CHD) are the most common type of developmental anomalies in children. At present the early diagnosis of congestive heart failure (CHF) and CHF-associated pathologic conditions is becoming increasingly important for optimization of protocols for following up pediatric patients in the primary health care settings.Objective. The study aimed at determining the prognostic role of brain natriuretic peptide (BNP) as a diagnostic marker of CHF progression and development of CHF-associated pathological conditions in babies with CHD during the first year of life.Methods. A prospective cohort study was carried out in a total of 114 children of the first year of life. The main study group was comprised of 61 children with confirmed diagnosis of CHD, and the control group of 53 health status group I–IIA children without CHD.Results. Diagnostic role of BNP elevation &gt; 30 pg/mL was determined. At this BNP level the risk for developing stage 2A CHF increased 7-fold (OR 7.5 [1.8–31.5]), for developing functional class (FC) 2 CHF — nearly 5-fold (OR 4.6 [1.3–16.0]), and for FC 3 CHF such risk increased 9-fold (OR 9.2 [2.3–36.1]). Our results demonstrated that the BNP level measurements can be used in clinical practice to determine the likelihood of persistence of symptoms of perinatal CNS injuries during the first year of life (OR 7.6 [1.7–34.5]) and protein and energy deficit (PED) (OR 9.5 [2.5–35.5]) in children with CHD.

Cardio embolic stroke and blood biomarkers: diagnosis and predictors of short-term outcome

BackgroundThe brain is a productive source of a variety of enzymes and any brain injury like a stroke to brain tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and serum. Evaluation of these enzymes represents a simple method for the ischemic stroke subtype diagnosis and prognosis. Objective: This study aimed to determine the role of brain natriuretic peptide (BNP), d-dimer, creatine–kinase-MB (CK-MB), C-reactive protein (CRP) serum levels, and globulin/albumin ratio in the diagnosis of CES stroke and its ability to predict short-term outcome.MethodsThis study was conducted on 96 patients with acute ischemic stroke, subdivided into two groups: group Ι was 48 patients with cardio-embolic stroke and group ΙΙ was 48 patients with non-cardio-embolic. All patients were subjected to the assessment of serum BNP, d-dimer and CK-MB, and CRP and globulin/albumin ratio within the first 24 h of stroke. In the third week, they were assessed by mRS.ResultsThe mean levels of BNP, d-dimer level, and CK-MB were significantly higher in patients with cardio-embolic stroke than in patients with non-cardio-embolic stroke (P < 0.001) and also were associated with poor short-term outcome.ConclusionElevated plasma levels of BNP, d-dimer levels, and CK-MB can be used as surrogate biomarkers for the diagnosis of cardio-embolic stroke and prediction of poor short-term outcomes.

BNP as a Major Player in the Heart-Kidney Connection

Brain natriuretic peptide (BNP) is an important biomarker for patients with heart failure, hypertension and cardiac hypertrophy. Although it is known that BNP levels are relatively higher in patients with chronic kidney disease and no heart disease, the mechanism remains unknown. Here, we review the functions and the roles of BNP in the heart-kidney interaction. In addition, we discuss the relevant molecular mechanisms that suggest BNP is protective against chronic kidney diseases and heart failure, especially in terms of the counterparts of the renin-angiotensin-aldosterone system (RAAS). The renal medulla has been reported to express depressor substances. The extract of the papillary tips from kidneys may induce the expression and secretion of BNP from cardiomyocytes. A better understanding of these processes will help accelerate pharmacological treatments for heart-kidney disease.

The role of Brain Natriuretic Peptide in evaluating Left Ventricle function among patient with chronic renal failure on maintenance hemodialysis: the impact of body mass index

Both chronic renal failure (CRF) and heart failure (HF) can predispose to pressure load or volume overload with subsequent elevation of serum brain natriuretic peptide (BNP) levels. This study tends to evaluate the role of BNP as a predictor of left ventricular function among patient with chronic renal failure on maintenance hemodialysis. Methods: This is a perspective cross-sectional study, including 89 (45 males and 44 females) patients on maintenance hemodialysis followed up for six months. BNP level, glomerular filtration and body mass index of the patients were measured and left ventricular function (EF%) was detected by echocardiography at the start of the study and after three and six months between October 2016 and April 2017.Results:Of 89 patients, 13 were underweight, 56 had a healthy weight, and 20 were overweight. There was a significant negative association between BNP level and both EF% and BMI (P<0.001, P<0.001) respectively. During the follow up of these patients there was a clear trend for BNP to be higher among patients with impaired left the ventricular function. There was also a strong inverse association between BNP level and GFR (P <0.001).Conclusion: BNP levels show a strong inverse association with EF%, BMI and GFR in patients with CRF. Currently, BNP widely used by most health institutions to predict left ventricular function. However, both BMI and GFR considered a significant confounder of BNP measurement in patients with compromised renal status.

Accurate etiology diagnosis in patients with stroke and atrial fibrillation: A role for brain natriuretic peptide

BackgroundAtrial fibrillation (AF) is the leading cause of cardioembolic stroke (CES), and patients with stroke and AF are frequently assumed to have CES. However, strokes presumably due to atherosclerotic pathophysiologies in large or small vessels can also occur in patients with AF. The aims of the present study were to clarify the prevalence of and factors related to a non-cardioembolic etiology in acute stroke patients with AF. MethodsFrom March 2011 through May 2017, consecutive acute ischemic stroke patients with AF were retrospectively recruited. The concomitant presence of non-cardioembolic features (small vessel occlusion [SVO] or large artery atherosclerosis [LAA]) on imaging was evaluated. The frequency of and factors associated with co-existing SVO/LAA features were assessed. ResultsA total of 560 consecutive patients with AF and acute stroke (237 women; median age 78 [IQR 71–85] years; NIHSS score 9 [3-20]) were enrolled. Of these, 42 (7.5%) had co-existing SVO/LAA features. Multivariable logistic regression analysis showed that the brain natriuretic peptide level (BNP, OR 0.78, p = .030 per 100 pg/mL increase) was independently and negatively associated with co-existing SVO/LAA features and receiver operating characteristic curve analysis revealed the practical cut-off BNP value was 130 pg/mL (sensitivity 54% and specificity 68%). ConclusionSVO/LAA features were found in 7.5% of acute stroke patients with AF. A relatively low BNP level on admission was independently associated with co-existing SVO/LAA features. Thorough examination for a more appropriate etiology may be particularly necessary in acute stroke patients with AF and a relatively low BNP level.

The role of brain natriuretic peptides as a marker for diagnosing cardiac syncope: A narrative review

Cardiac disease is the second common cause of syncope in emergency departments. Patients with Cardiac syncope have a higher risk of mortality than those who have a non-cardiac problem. Brain natriuretic peptide (BNP) as a cardiac marker has not thoroughly been evaluated in patients with syncope. This article focuses on the studies that have assessed BNP and NT-pro-BNP in cardiac and non-cardiac syncope patients in emergency departments.

Role of brain natriuretic peptide as an independent predictor of short term outcome in patients with cardiac resynchronization therapy

Role of brain natriuretic peptide as an independent predictor of short term outcome in patients with cardiac resynchronization therapy

Double trouble: managing diabetic emergencies in patients with heart failure

Double trouble: managing diabetic emergencies in patients with heart failure

Involvement of brain natriuretic peptide signaling pathway in the cardioprotective action of sitagliptin.

The current study is focusing on the role of brain natriuretic peptide (BNP), a substrate of dipeptidyl peptidase-4 (DPP-4) enzyme, and its signaling survival pathway in the cardioprotective mechanism of sitagliptin, a DPP-4 inhibitor. Male Wistar rats were randomized into 7 groups, sham, I/R, KT-5823 (selective protein kinase (PK) G inhibitor), 5-HD (selective mito-KATP channel blocker), sitagliptin (300mg/kg, po), sitagliptin+KT-5823, and sitagliptin+5-HD. Sitagliptin was administered for 3 days prior to induction of coronary I/R, while either KT-5823 or 5-HD was administered intravenously 5min before coronary ligation. Pretreatment with sitagliptin provided significant protection against I/R injury as manifested by decreasing, percentage of infarct size, suppressing the elevated ST segment, reducing the increased cardiac enzymes, as well as DPP-4 activity and elevating both heart rate (HR) and left ventricular developed pressure (LVDP). However, the addition of either blocker to sitagliptin regimen reversed partly its cardioprotective effects. Although I/R increased BNP content, it unexpectedly decreased that of cGMP; nevertheless, sitagliptin elevated both parameters, an effect that was not affected by the use of the two blockers. On the molecular level, sitagliptin decreased caspase-3 activity and downregulated the mRNA levels of BNP, Bax, and Cyp D, while upregulated that of Bcl2. The use of either KT-5823 or 5-HD with sitagliptin hindered its effect on the molecular markers tested. The results of the present study suggest that the cardioprotective effect of sitagliptin is mediated partly, but not solely, through the BNP/cGMP/PKG survival signaling pathway.