Affiliations: Chicago, IL
Dr. Rubinstein is an Associate Professor and Dr. Hong is an Assistant
Professor at the University of Illinois at Chicago.
Correspondence to: Israel Rubinstein, MD, Department of Medicine (M/C 787), University of Illinois at Chicago, 840 South Wood Street, Chicago, IL 60612-7323; e-mail: IRubinst@uic.edu
The family of natriuretic peptides comprises five
structurally-related 22-53-amino acid peptides, atrial natriuretic
peptide (ANP), brain natriuretic peptide (BNP), two C-type natriuretic
peptides (CNP), and dendroaspis natriuretic peptide
(DNP).1 They express broad and disparate effects in the
cardiovascular system, including natriuresis, diuresis, vasodilation,
and inhibition of the renin-angiotensin system, sympathetic outflow,
and vascular smooth muscle and endothelial cell
The salutary cardiovascular effects of natriuretic peptides
suggest that they could play a pivotal role in mitigating the
deleterious effects of phlogistic mediators elaborated during the host
inflammatory response to injury, including cardiovascular
surgery.2,,3,,4 However, data compiled from large-scale
clinical trials seem to indicate that an increase in circulating
levels of natriuretic peptides and their degradation products during
the early phase after myocardial infarction is an independent predictor
of left ventricular dysfunction and death.5,,6,,7
Although the mechanisms underlying this process are uncertain,
they may be related, in part, to increased production and/or decreased
degradation and inactivation of these peptides in inflamed
tissues.1 Nonetheless, Amano and colleagues8
showed that unilateral pulmonary artery occlusion in patients with lung
cancer is associated with a significant decrease in ANP level in the
coronary sinus which is reversed by atropine. These data imply that ANP
secretion is modulated, in part, by the parasympathetic nervous system.
To this end, Berkenstadt and colleagues in this issue of
CHEST (see page 130), found that circulating ANP levels are
increased during and after short-term balloon occlusion of the thoracic
aorta in patients with inoperable intraabdominal malignancy undergoing
vascular bed-selective high dose chemotherapy. They suggested that
circulating ANP level is determined, in part, by factors other than
arterial wall stretch and transmural pressure. However, they did not
report on circulating BNP levels nor correlated ANP levels with
Circulating ANP levels are also increased in patients undergoing
elective cardiac surgery.2,,3,,4 However, only a small number
of patients were studied, and no correlation between ANP level and
short- and long-term outcome was sought. Importantly, circulating BNP
level, which correlates better with left ventricular dysfunction and
survival than ANP in patients with MI,7 was not
On balance, these data suggest that tissue-specific natriuretic
peptides are elaborated early in the course of inflammation and may
serve as a simple and reliable biologic marker of its progression and
patient’s survival. However, the sensitivity and specificity of this
response, as assessed by circulating natriuretic peptides levels,
should be determined in large scale, prospective multicenter studies.
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