LETTER TO THE EDITOR
Exercise release of cardiac natriuretic peptides is markedly enhanced when patients with coronary artery disease are treated medically by beta-blockers
Htuk Kyaw Win, MD and
William A. Zoghbi, MD, FACC
Baylor College of Medicine, 6550 Fannin, SM677, Houston, TX 77030
(Email: wzoghbi{at}bcm.tmc.edu).
We read with interest the recent study by Marie et al. (1), which concluded that patients with chronic coronary artery disease exhibited much higher exercise release of (ANP) and brain natriuretic peptide (BNP) when they were treated with beta-blockers. Exercise-related increase in natriuretic peptides had been reported across a majority of patients undergoing exercise treadmill test for evaluation of ischemic heart disease (2–5). The investigators postulated that the mechanisms of enhanced natriuretic peptide release secondary to beta-blockade may be related to exercise-induced increase in wall tension and cavity size. However, the researchers did not report the presence of reversible ischemia among the patients who were receiving beta-blocker therapy.
We recently reported (6) that exercise-induced increase in B-type natriuretic peptide was more prominent in patients with evidence of reversible ischemia on single-photon emission computed tomography (SPECT). It is therefore possible that the presence of exercise-induced reversible ischemia may serve as a confounding factor in this patient population, and we wonder whether the BNP rise among patients receiving beta-blockers during exercise is significant if the data are adjusted for presence of reversible ischemia.
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References
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- Marie PY, Mertes PM, Hassan-Sebbag N, et al. Exercise release of cardiac natriuretic peptides is markedly enhanced when patients with coronary artery disease are treated medically by beta-blockers J Am Coll Cardiol 2004;43:353-359.[Abstract/Free Full Text]
- Onuoha GN, Nicholls DP, Patterson A, Beringer T. Neuropeptide secretion in exercise Neuropeptides 1998;32:319-325.[CrossRef][Medline]
- Nicholson S, Richards M, Espiner E, Nicholls G, Yandle T. Atrial and brain natriuretic peptide response to exercise in patients with ischaemic heart disease Clin Exp Pharmacol Physiol 1993;20:535-540.[Medline]
- Huang WS, Lee MS, Perng HW, Yang SP, Kuo SW, Chang HD. Circulating brain natriuretic peptide values in healthy men before and after exercise Metabolism 2002;51:1423-1426.[CrossRef][Medline]
- Marumoto K, Hamada M, Hiwada K. Increased secretion of atrial and brain natriuretic peptides during acute myocardial ischaemia induced by dynamic exercise in patients with angina pectoris Clin Sci (Lond) 1995;88:551-556.[Medline]
- Htuk Kyaw Win, Su-Min Chang, Michael Raizner, et al. Changes in B-type natriuretic peptide level during treadmill exercise in subjects with and without evidence of reversible myocardial ischemia. Presented at: Scientific Sessions 2003, American Heart Association, Orlando, FL, 2003..
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