Published Online
on December 1, 2003

A more recent version of this article appeared on January 1, 2004

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Submitted on July 18, 2003
Revised on August 13, 2003

Amino-Terminal Pro-C-Type Natriuretic Peptide in Heart Failure

Sue P. Wright; Tim C.R. Prickett; Robert N. Doughty; Chris Frampton; Greg D. Gamble; Tim G. Yandle; Norman Sharpe; and Mark Richards^*

From the Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand, and Christchurch Cardioendocrine Research Group, Department of Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.

^* To whom correspondence should be addressed. E-mail: mark.richards{at}cdhb.govt.nz.

Abstract--The levels and pathophysiological role of amino terminal C-type natriuretic peptide in heart failure are unknown. The potential of plasma amino-terminal C-type natriuretic peptide (N-CNP) as a marker of cardiac function was investigated in symptomatic patients. In 305 patients with recent-onset dyspnea and/or peripheral edema, presenting to primary care, assay of plasma amino-terminal C-type natriuretic peptide and other plasma vasoactive hormones was conducted together with echocardiography. Heart failure was diagnosed in 77 (of the 305) patients by rigorous application of predefined criteria. Plasma amino-terminal C-type natriuretic peptide concentrations were elevated in patients with heart failure, and by univariate analysis were related to age, renal function, and other hormones. On multivariate analysis, tertile of plasma N-CNP interacted with tertile of plasma amino-terminal B-type natriuretic peptide to predict heart failure independent of age, gender, renal function, or echocardiographic left ventricular fractional shortening. N-CNP showed significant relations to concurrent plasma CNP, atrial natriuretic peptide (ANP), N-ANP, B-type (or brain) natriuretic peptide (BNP), N-BNP, endothelin-1, and adrenomedullin but not to echocardiographic indicators of left ventricular systolic function. Plasma amino-terminal C-type natriuretic peptide is elevated in heart failure and is related to other plasma hormones in heart failure. These findings suggest a possible compensatory response from the peripheral vasculature to heart failure by an endothelium-based vasodilator peptide and mandate further exploration of the role of C-type natriuretic peptide in this condition.

Key words: natriuretic peptides • heart failure • echocardiography • hormones

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