CLINICAL STUDY
Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects
Hans P. Brunner-La Rocca, MD*,1,
David M. Kaye, MBBS, PhD, FRACP, FACC*,2,
Robyn L. Woods, PhD ,
Jacqueline Hastings, PhD* and
Murray D. Esler, MBBS, PhD, FRACP*
* Alfred and Baker Medical Unit, Baker Medical Research Institute, Alfred Hospital, Melbourne, Australia
Howard Florey Institute, University of Melbourne, Parkville, Australia
Manuscript received August 12, 2000;
revised manuscript received December 6, 2000,
accepted December 27, 2000.
Reprint requests and correspondence: Dr. Hans Peter Brunner-La Rocca, Division of Cardiology/Department of Internal Medicine, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland
hanspeter.brunner{at}dim.usz.ch
OBJECTIVES
We sought to assess the effects of brain natriuretic peptide (BNP) on systemic and regional sympathetic nervous activity (SNA) in both patients with congestive heart failure (CHF) and healthy control subjects.
BACKGROUND
Although the response of SNA to atrial natriuretic peptide (ANP) has been well documented, the response of SNA to BNP is largely unknown.
METHODS
We assessed cardiac and whole-body SNA using the norepinephrine (NE) tracer dilution method before and after infusion of two doses of BNP (3 and 15 ng/kg body weight per min) in 11 patients with stable CHF (ejection fraction 24 ± 2%) and 12 age-matched healthy control subjects. In addition, renal SNA and hemodynamic variables were assessed at baseline and after the higher BNP dose.
RESULTS
Low dose BNP did not change blood pressure or whole-body NE spillover, but reduced cardiac NE spillover in both groups by 32 ± 13 pmol/min (p < 0.05). In both groups, high dose BNP reduced pulmonary capillary pressure by 5 ± 1 mm Hg (p < 0.001) and mean arterial pressure by 6 ± 3 mm Hg (p < 0.05), without a concomitant increase in whole-body NE spillover; however, cardiac NE spillover returned to baseline levels. Renal NE spillover remained virtually unchanged in healthy control subjects (501 ± 120 to 564 ± 115 pmol/min), but was reduced in patients with CHF (976 ± 133 to 656 ± 127 pmol/min, p < 0.01).
CONCLUSIONS
Our results demonstrate a sympathoinhibitory effect of BNP. Cardiac sympathetic inhibition was observed at BNP concentrations within the physiologic range, whereas high dose BNP, when arterial and filling pressures fell and reflex sympathetic stimulation was expected, systemic and cardiac SNA equated to baseline values. There was inhibition of renal SNA in patients with CHF, but not in healthy control subjects. Whether this effect is specific to BNP or related to reduced filling pressure remains to be determined.
|
Abbreviations and Acronyms
| | ANP | = atrial natriuretic peptide | | BNP | = brain, or b-type, natriuretic peptide | | CHF | = congestive heart failure | | NE | = norepinephrine | | NP | = natriuretic peptides | | RAAS | = renin-angiotensin-aldosterone system | | SNS | = sympathetic nervous system |
|
This article has been cited by other articles:
|
|
|
|
 
O. M. Gutierrez, J. L. Januzzi, T. Isakova, K. Laliberte, K. Smith, G. Collerone, A. Sarwar, U. Hoffmann, E. Coglianese, R. Christenson, et al.
Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Chronic Kidney Disease
Circulation,
May 19, 2009;
119(19):
2545 - 2552.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Giannitsis, H. J. Roth, R. M. Leithauser, J. Scherhag, R. Beneke, and H. A. Katus
New Highly Sensitivity Assay Used to Measure Cardiac Troponin T Concentration Changes During a Continuous 216-km Marathon
Clin. Chem.,
March 1, 2009;
55(3):
590 - 592.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Burnett Jr and J. Korinek
The Tumultuous Journey of Nesiritide: Past, Present, and Future
Circ Heart Fail,
May 1, 2008;
1(1):
6 - 8.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R J Hillock, C M Frampton, T G Yandle, R W Troughton, J G Lainchbury, and A M Richards
B-type natriuretic peptide infusions in acute myocardial infarction
Heart,
May 1, 2008;
94(5):
617 - 622.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Toader, R. M. McAllen, A. Cividjian, R. L. Woods, and L. Quintin
Effect of systemic B-type natriuretic peptide on cardiac vagal motoneuron activity
Am J Physiol Heart Circ Physiol,
December 1, 2007;
293(6):
H3465 - H3470.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Witteles, D. Kao, D. Christopherson, K. Matsuda, R. H. Vagelos, D. Schreiber, and M. B. Fowler
Impact of Nesiritide on Renal Function in Patients With Acute Decompensated Heart Failure and Pre-Existing Renal Dysfunction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
J. Am. Coll. Cardiol.,
November 6, 2007;
50(19):
1835 - 1840.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. L Chow, J. T Peng, M. P Okamoto, and J T. Heywood
Effect of Nesiritide Infusion Duration on Renal Function in Acutely Decompensated Heart Failure Patients
Ann. Pharmacother.,
April 1, 2007;
41(4):
556 - 561.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Mentzer Jr, M. C. Oz, R. N. Sladen, A. H. Graeve, R. F. Hebeler Jr, J. M. Luber Jr, N. G. Smedira, and on behalf of the NAPA Investigators
Effects of Perioperative Nesiritide in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery: The NAPA Trial
J. Am. Coll. Cardiol.,
February 13, 2007;
49(6):
716 - 726.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kasama, T. Toyama, T. Hatori, H. Sumino, H. Kumakura, Y. Takayama, S. Ichikawa, T. Suzuki, and M. Kurabayashi
Effects of Intravenous Atrial Natriuretic Peptide on Cardiac Sympathetic Nerve Activity and Left Ventricular Remodeling in Patients With First Anterior Acute Myocardial Infarction
J. Am. Coll. Cardiol.,
February 13, 2007;
49(6):
667 - 674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Belluardo, A. Cataliotti, L. Bonaiuto, E. Giuffre, E. Maugeri, P. Noto, G. Orlando, G. Raspa, B. Piazza, L. Babuin, et al.
Lack of activation of molecular forms of the BNP system in human grade 1 hypertension and relationship to cardiac hypertrophy
Am J Physiol Heart Circ Physiol,
October 1, 2006;
291(4):
H1529 - H1535.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. H. Chen and J. C. Burnett Jr
Clinical application of the natriuretic peptides in heart failure
Eur. Heart J. Suppl.,
September 1, 2006;
8(suppl_E):
E18 - E25.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. G. Riter, M. M. Redfield, J. C. Burnett, and H. H. Chen
Nonhypotensive Low-Dose Nesiritide Has Differential Renal Effects Compared With Standard-Dose Nesiritide in Patients With Acute Decompensated Heart Failure and Renal Dysfunction
J. Am. Coll. Cardiol.,
June 6, 2006;
47(11):
2334 - 2335.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P.A. Gould, J. D'Agostino, H.G. Schneider, and D.M. Kaye
Influence of atrial fibrillation on cardiac brain natriuretic peptide release during haemodynamic stress in heart failure
Eur J Heart Fail,
May 1, 2006;
8(3):
263 - 269.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Clerico, F. A. Recchia, C. Passino, and M. Emdin
Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications
Am J Physiol Heart Circ Physiol,
January 1, 2006;
290(1):
H17 - H29.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Petersson, P. Friberg, G. Lambert, and B. Rundqvist
Decreased renal sympathetic activity in response to cardiac unloading with nitroglycerin in patients with heart failure
Eur J Heart Fail,
October 1, 2005;
7(6):
1003 - 1010.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Onat, J. Stathopoulos, A. Rose, K. Newman, R. R Sciacca, U. P Jorde, and P. C Colombo
Reliability of Nesiritide Infusion via Non-Primed Tubing and Heparin-Coated Catheters
Ann. Pharmacother.,
October 1, 2005;
39(10):
1617 - 1619.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Goetze and R. Videbaek
More hormones spilt in heart failure: linking renal sympathetic activation to clinical outcome
Eur. Heart J.,
May 1, 2005;
26(9):
861 - 862.
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Ozdemir, O. Alyan, M. Soylu, F. Metin, F. Kacmaz, A. D. Demir, B. Geyik, D. Aras, H. Sasmaz, and S. Korkmaz
Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy
Europace,
January 1, 2005;
7(3):
204 - 210.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J Thomas and R. L Woods
Do natriuretic peptides modify arterial baroreflexes in sheep?
Exp Physiol,
November 1, 2004;
89(6):
709 - 715.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Komarek, A. Bernheim, R. Schindler, R. Steden, W. Kiowski, and H. P. B.-L. Rocca
Vascular Effects of Natriuretic Peptides in Healthy Men
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2004;
9(4):
263 - 270.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A Luchner and H Schunkert
Interactions between the sympathetic nervous system and the cardiac natriuretic peptide system
Cardiovasc Res,
August 15, 2004;
63(3):
443 - 449.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. C. Kurian, I. J. Wagner, and M. Klapholz
Nesiritide in Pulmonary Hypertension
Chest,
July 1, 2004;
126(1):
302 - 305.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Al-Hesayen and J. D. Parker
Impaired Baroreceptor Control of Renal Sympathetic Activity in Human Chronic Heart Failure
Circulation,
June 15, 2004;
109(23):
2862 - 2865.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. de Denus, C. Pharand, and D. R. Williamson
Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone
Chest,
February 1, 2004;
125(2):
652 - 668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kyuma, T. Nakata, A. Hashimoto, K. Nagao, H. Sasao, T. Takahashi, K. Tsuchihashi, and K. Shimamoto
Incremental Prognostic Implications of Brain Natriuretic Peptide, Cardiac Sympathetic Nerve Innervation, and Noncardiac Disorders in Patients with Heart Failure
J. Nucl. Med.,
February 1, 2004;
45(2):
155 - 163.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. U. Pliquett, K. G. Cornish, K. P. Patel, H. D. Schultz, J. D. Peuler, and I. H. Zucker
Amelioration of depressed cardiopulmonary reflex control of sympathetic nerve activity by short-term exercise training in male rabbits with heart failure
J Appl Physiol,
November 1, 2003;
95(5):
1883 - 1888.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. H Chee, K. Amudha, N. A Hussain, H. K Haizal, A.-M. J Choy, and C. C Lang
Combination of drugs acting on the natriuretic system and the renin-angiotensin system in heart failure
Journal of Renin-Angiotensin-Aldosterone System,
September 1, 2003;
4(3):
140 - 148.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. D. Michaels, A. Klein, J. A. Madden, and K. Chatterjee
Effects of Intravenous Nesiritide on Human Coronary Vasomotor Regulation and Myocardial Oxygen Uptake
Circulation,
June 3, 2003;
107(21):
2697 - 2701.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Tsuruda, G. Boerrigter, B. K. Huntley, J. A. Noser, A. Cataliotti, L. C. Costello-Boerrigter, H. H. Chen, and J. C. Burnett Jr
Brain Natriuretic Peptide Is Produced in Cardiac Fibroblasts and Induces Matrix Metalloproteinases
Circ. Res.,
December 13, 2002;
91(12):
1127 - 1134.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Sodian, M. Loebe, C. Schmitt, E. V. Potapov, H. Siniawski, J. Muller, H. Hausmann, H. R. Zurbruegg, Y. Weng, and R. Hetzer
Decreased plasma concentration of brain natriuretic peptide as a potential indicator of cardiac recovery in patients supported by mechanical circulatory assist systems
J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
1942 - 1949.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
