Natriuretic Peptides : The Hormones of the Heart

Modern cardiovascular science has produced a revolutionary new idea: the heart acts not merely as a pump, but as a "gland", that is as a regulator of circulatory homeostasis and salt-water balance. This book combines the classical heamodynamic view with the new neuro-hormonal paradigm, in all its potential clinical implications. The book will interest physiologists and clinicians involved in the study of the cardiovascular system and care of heart patients. Contents......Page 6 About the Authors......Page 9 Abbreviations......Page 11 1.1 Historical Background......Page 13 1.2 Book Aim and Plan......Page 15 2.2 Heart Physiology: the Classical View......Page 19 2.3.1 Premises on the Neuro-Humoral Control of the Cardiovascular System......Page 20 2.3.2 Autonomic Control of Heart Rate......Page 21 2.3.3 Afferent Stimuli......Page 23 2.3.4 Efferent Neural Connections......Page 26 2.3.5 Spinal Cord......Page 27 2.3.6 Medullary Centers......Page 28 2.4 The Integrated Neuro-Hormonal Response: Short- and Long-Term Response......Page 30 2.5 Heart Physiology: What is New?......Page 31 3.1 Chemical Structure and Gene Evolution of Cardiac Natriuretic Hormones......Page 33 3.2 Genes Encoding for Cardiac Natriuretic Hormones......Page 36 3.3 Regulation of Production/Secretion of ANP and BNP in Cardiac Tissue......Page 40 3.4 Biological Action of CNH......Page 46 3.5.2 Biological Function of NPRs......Page 51 3.6 Metabolic Pathways and Circulating Levels of CNH......Page 55 3.6.2 BNP Metabolism......Page 56 3.7 CNH System in Fetal Heart and Circulation......Page 58 3.8 CNH Genes and Cardiovascular Diseases......Page 59 3.9 An Integrated Neuro-Hormonal System Regulates Vascular Function......Page 61 3.10 Summary and Conclusion......Page 63 4.1 General Considerations......Page 77 4.2.1 Competitive Immunoassay Methods for ANP......Page 79 4.2.2 Non-Competitive Immunoassay Methods for ANP......Page 81 4.3.1 First-Generation (Manual) BNP Assays......Page 83 4.3.2 Second-Generation (Automated) BNP Assays......Page 84 4.3.3 Determination of NT-proBNP......Page 85 4.3.4 Specificity of BNP/NT-proBNP Assays......Page 86 4.3.5 Quality Specifications for BNP/NT-proBNP Assays......Page 89 4.4 Determination of Other Natriuretic Peptides (CNP, DNP, and Urodilatin)......Page 91 4.5 Summary and Perspectives......Page 94 5.1.1 Influence of Age and Gender......Page 102 5.1.3 Resistance to the Biological Action of CNH......Page 105 5.1.4 Diagnostic Accuracy of CNH Assay in Plasma from Patients with Cardiac Diseases......Page 110 5.1.5 Biological Variation of Plasma BNP: a Problem or a Clinical Resource?......Page 114 5.2 CNH Assay as Diagnostic and Prognostic Tool in Cardiac Diseases......Page 115 5.2.2 Diagnostic Accuracy of CNH Assay in Asymptomatic, Mild Ventricular Systolic Dysfunction......Page 116 5.2.3 Diagnostic Accuracy of CNH Assay in Patients with Suspected HF......Page 117 5.2.5 Diagnostic Accuracy of CNH Assay in Elderly People......Page 119 5.2.6 Detection of Drug Cardiotoxicity by means of BNP Assay......Page 120 5.3 Comparison between the Diagnostic Accuracy of CNH Assay and that of Other Tests and Clinical Investigations......Page 121 5.4.1 Prognosis in HF......Page 123 5.4.2 Prognosis in ACS......Page 124 5.5.1 Clinical Relevance of CNH Assay in Tailoring the Therapy of HF......Page 125 5.5.2 Cost-Effectiveness of CNH Assay in Management of Patients with Acute or Chronic HF......Page 127 5.6 Summary and Conclusion......Page 128 6.1 Introduction......Page 144 6.2 Pulmonary Diseases......Page 145 6.3 Kidney Diseases......Page 147 6.4 Acute and Chronic Inflammatory Diseases......Page 149 6.5 CNH Assay in Cerebrovascular Disease......Page 150 6.7 Thyroid Diseases......Page 152 6.8 Diabetes Mellitus......Page 154 6.9 Obesity......Page 157 6.10 Adrenal Gland Diseases......Page 158 6.11 Summary and Conclusion......Page 159 7.2 Effects of Antagonists of Neuro-Hormonal Activation on CNH System......Page 172 7.3 Treatments Targeting the Increase of Circulating Levels of CNH......Page 174 7.3.2 Use of Synthetic Natriuretic Peptides: Clinical Trials......Page 175 7.4 Pharmacological Blockade of Degradation and Receptor Antagonism......Page 178 7.5 Combined ACE and NEP Inhibition......Page 180 7.6 Conclusive Remarks......Page 181 8 "Inconclusive" Remarks: Past, Present and Future of Natriuretic Peptides......Page 187 B......Page 188 D......Page 189 H......Page 190 M......Page 191 S......Page 192 Z......Page 193 The rapid knowledge in the field of neuro-humoral regulation of cardiovascular pathophysiology is changing the picture of current diagnosis and treatment of cardiac patients. The emerging conceptual revolutionary idea is that heart acts not as a pump, merely, but as a ""gland"", that is as a regulator of circulatory homeostasis and salt-water balance. Cardiovascular pathophysiology has to be written, indeed, on this basis: this physiology textbook gives an up-to-date description of the complexity and novelty of actual knowledge, with all its potential clinical implications The rapid evergrowing knowledge in the field of neuro-humoral regulation of cardiovascular pathophysiology is changing the picture of current diagnosis and treatment of cardiac patients. The emerging conceptual revolutionary idea is that heart acts not as a pump, merely, but as a "gland," that is as a regulator of circulatory homeostasis and salt-water balance