title: Cardiac natriuretic hormones, neuro-hormones, thyroid hormones and cytokines in normal subjects and patients with heart failure.
abstract: The derangement of neuro-endocrine control of circulation influences both disease evolution and response to treatment in patients with heart failure, but little data are available about the complex relationships between the degree of neuro-hormonal activation and clinical severity. We studied the relationships between cardiac natriuretic hormones (CNHs) and several neuro-hormones and immunological markers in a prospective cohort of 105 consecutive patients with cardiomyopathy (77 men and 28 women, mean age 66.7+/-12.4 years, range 33-89 years). We assayed the circulating levels of CNHs (atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)), plasma renin activity (PRA), aldosterone, cortisol, adrenaline, noradrenaline, thyroid hormones and thyroid stimulating hormone (TSH), tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). The concentrations of all CNHs and neurohormones were higher in patients with heart failure compared to normal subjects, except for free triiodothyronine (FT3), which was below normal values. ANP was positively related to NYHA class, IL-6, adrenaline, noradrenaline and cortisol, while negatively with ejection fraction and FT3. BNP was positively related to age, NYHA class, IL-6, TNF-alpha, adrenaline, noradrenaline and cortisol, while negatively with ejection fraction and FT3. A stepwise multiple linear regression indicated that plasma ANP depended only on ejection fraction, adrenaline and noradrenaline values, while for plasma BNP variation NYHA class contributed too. Our data confirm a progressive activation of hormonal and immunological systems in patients with heart failure. Furthermore, CNH circulating levels in heart failure are affected not only by cardiac function and disease severity, but also by activation of neuro-hormonal and stress-related cytokine systems, as well as by the thyroid hormones, even on usual medical treatment.
authors.affiliation: Laboratory of Cardiovascular Endocrinology and Cell Biology, C.N.R. Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Concetta
authors.initials: C
authors.lastname: Prontera
authors.forename: Annalisa
authors.initials: A
authors.lastname: Iervasi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ripoli
authors.forename: Silvano
authors.initials: S
authors.lastname: Masini
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Zucchelli
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000097:blood*; D011237:Predictive Value of Tests; D012016:Reference Values; D012737:Sex Factors; D013963:Thyroid Hormones / Q000097:blood*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D045283:Natriuretic Agents; D013963:Thyroid Hormones; D003346:Corticotropin-Releasing Hormone