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The cyclic guanosine monophosphate/B-type natriuretic peptide ratio and mortality in advanced heart failure.
MedLine Citation:
PMID:  19168517     Owner:  NLM     Status:  MEDLINE    
AIMS: Attenuation of the effects of natriuretic peptides has been demonstrated in animal models but studies in humans are scarce, particularly concerning renal attenuation. We investigated the attenuation of B-type natriuretic peptide (BNP) in chronic advanced heart failure (HF).
METHODS AND RESULTS: We included 62 outpatients with HF and severe left ventricular systolic dysfunction. Cases had at least one hospital admission or emergency department visit for acute HF in the previous year and were in NYHA class III/IV despite optimized therapy. The individual age- and sex-matched controls were symptomatically controlled (NYHA I and II). We collected 24 h urine and a blood sample from all patients. Plasma BNP and plasma (pcGMP) and urine cyclic guanosine monophosphate (ucGMP) were measured. Patients were followed for 3 months for hospital admission or all-cause death. ucGMP to plasma BNP (ucGMP/BNP) ratio was attenuated in cases vs. controls [median (IQR): 8354 (4293-16,456) vs. 12,693 (6896-22,851)]. There were no differences in pcGMP to BNP (pcGMP/BNP) ratio or urine cGMP excretion. Patients with worse outcome had lower pcGMP/BNP [260 (86-344) vs. 381 (244-728) in patients without adverse outcome events] and lower ucGMP/BNP [4146 (2207-9363) vs. 10,922 (7495-19,971)].
CONCLUSION: Renal NP's second messenger production is attenuated in advanced HF. Patients with worse outcome have lower ucGMP/BNP and pcGMP/BNP ratios.
Patrícia Lourenço; José Paulo Araújo; Ana Azevedo; António Ferreira; Paulo Bettencourt
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of heart failure     Volume:  11     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-26     Completed Date:  2009-04-16     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  185-90     Citation Subset:  IM    
Serviço de Medicina Interna, Hospital S. João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, 4202-451 Porto, Portugal.
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MeSH Terms
Chronic Disease
Creatinine / blood
Cyclic GMP / metabolism*
Heart Failure / metabolism,  mortality*,  physiopathology
Natriuretic Peptide, Brain / blood*
Second Messenger Systems
Ventricular Dysfunction, Left / complications
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain; 60-27-5/Creatinine; 7665-99-8/Cyclic GMP

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