title: B-type natriuretic peptide release in the coronary effluent after acute transient ischaemia in humans.
abstract: BACKGROUND
  The association between B-type natriuretic peptide (BNP) and coronary artery disease is not fully understood.
  
  
  OBJECTIVE
  To assess whether ischaemia per se is a stimulus for BNP secretion.
  
  
  METHODS
  University tertiary hospital, Spain (Virgen de la Arrixaca).
  
  
  METHODS
  Prospective interventional study.
  
  
  METHODS
  11 patients (55 (9) years, left ventricular ejection fraction (LVEF) 45% (7%) with a non-complicated anterior myocardial infarction (MI) and isolated stenosis of the left anterior descending (LAD) coronary artery, successfully treated by primary angioplasty.
  
  
  METHODS
  11.0 (0.9) days after MI, the LAD was occluded (20 min) for intracoronary infusion of progenitor cells. Blood samples were obtained from the femoral artery (peripheral circulation (PC)) and the coronary sinus (coronary circulation (CC)) immediately before and after coronary occlusion.
  
  
  METHODS
  BNP (pg/ml) was measured and ischaemia biomarkers were monitored.
  
  
  RESULTS
  During coronary occlusion, all patients experienced transitory chest pain and ST-segment dynamic changes. After coronary occlusion, lactic acid levels rose in CC (1.42 (0.63) -1.78 (0.68) ng/ml, p = 0.003). Myoglobin and cardiac troponin T did not differ in CC or PC at 24 h. No differences were found in LVEF (+0.18% (2.4)%, p = 0.86) and motion score index (-0.02 (0.06), p = 0.37). Before occlusion, BNP levels did not differ significantly in CC versus PC (253 (56) vs 179 (34), p = 0.093). After occlusion, BNP showed a significant increase in CC (vs 332 (61), p = 0.004), but no change occurred in PC (vs 177 (23), p = 0.93), and circulating BNP levels were higher in CC versus PC (p = 0.008).
  
  
  CONCLUSIONS
  In response to acute ischaemia, BNP levels immediately increase in coronary sinus but not at the peripheral level. BNP release in the coronary effluent may exert local beneficial effects.
authors: Department of Cardiology, University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain. dapascual@servicam.com
authors: Domingo A
authors: DA
authors: Pascual-Figal
authors: María J
authors: MJ
authors: Antolinos
authors: Antoni
authors: A
authors: Bayes-Genis
authors: Teresa
authors: T
authors: Casas
authors: Francisco
authors: F
authors: Nicolas
authors: Mariano
authors: M
authors: Valdés
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain