title: Exercise release of cardiac natriuretic peptides is markedly enhanced when patients with coronary artery disease are treated medically by beta-blockers.
abstract: OBJECTIVE
  This study sought to identify determinants of the exercise rise in plasma levels of cardiac natriuretic peptides (NPs) in patients with coronary artery disease (CAD).
  
  
  BACKGROUND
  During stress, there is a variable rise in the plasma level of NPs, but this rise frequently reaches levels that are known to lower the cardiac load and that thus might be beneficial to CAD patients.
  
  
  METHODS
  Plasma venous concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were determined at rest and peak exercise in 104 patients with chronic CAD who were referred to exercise thallium-201 ((201)Tl) single-photon emission computed tomography (SPECT) and radionuclide angiography.
  
  
  RESULTS
  The extent of scarred myocardium by (201)Tl-SPECT and patient age were the best independent predictors of NP concentrations at rest, but also of increases in NP concentration during exercise (all p < 0.001). Moreover, beta-blocking treatment was an additional and strong independent predictor of the increase in NP concentrations at exercise (p < 0.001 for ANP; p = 0.001 for BNP). On average, exercise increases in NP concentrations were more than twice as high in patients with (n = 55) than in those without (n = 49) beta-blocker treatment (ANP: +49 +/- 63 vs. +22 +/- 25 ng/l, p = 0.01; BNP: +24 +/- 5 vs. +11 +/- 15 ng/l, p = 0.04), whereas NP concentrations at rest were equivalent in the two groups (ANP: 34 +/- 34 vs. 30 +/- 33 ng/l, p = NS; BNP: 85 +/- 152 vs. 57 +/- 101 ng/l, p = NS).
  
  
  CONCLUSIONS
  Patients with chronic CAD exhibit much higher exercise releases of ANP and BNP when they are treated with beta-blockers. This enhanced secretion of potent vasodilating and natriuretic agents constitutes an original therapeutic mechanism for further protecting diseased hearts against stress.
authors.affiliation: Department of Nuclear Medicine, UPRES EA 3447, Nancy, France. py.marie@chu-nancy.fr
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Marie
authors.forename: Paul M
authors.initials: PM
authors.lastname: Mertes
authors.forename: Nathalie
authors.initials: N
authors.lastname: Hassan-Sebbag
authors.forename: Nicole
authors.initials: N
authors.lastname: de Talence
authors.forename: Karim
authors.initials: K
authors.lastname: Djaballah
authors.forename: Wassila
authors.initials: W
authors.lastname: Djaballah
authors.forename: Johan
authors.initials: J
authors.lastname: Friberg
authors.forename: Pierre
authors.initials: P
authors.lastname: Olivier
authors.forename: Gilles
authors.initials: G
authors.lastname: Karcher
authors.forename: Faïez
authors.initials: F
authors.lastname: Zannad
authors.forename: Alain
authors.initials: A
authors.lastname: Bertrand
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000096:biosynthesis* / Q000097:blood / Q000187:drug effects; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis / Q000097:blood / Q000187:drug effects; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D000319:Adrenergic beta-Antagonists; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor