of in The Role of the in the A Molecular for Generating cAMP and cGMP Signaling Cross-Talk Role of Phosphodiesterases and Implications for Cardiac Pathophysiology

Cyclic nucleotide phosphodiesterases regulate cAMP-mediated signaling by controlling intracellular cAMP content. The cAMP-hydrolyzing activity of several families of cyclic nucleotide phosphodiesterases found in human heart is regulated by cGMP. In the case of PDE2, this regulation primarily involves the allosteric stimulation of cAMP hydrolysis by cGMP. For PDE3, cGMP acts as a competitive inhibitor of cAMP hydrolysis. Several cGMP-mediated responses in cardiac cells, including a potentiation of Ca(2+) currents and a diminution of the responsiveness to beta-adrenergic receptor agonists, have been shown to result from the effects of cGMP on cAMP hydrolysis. These effects appear to be dependent on the specific spatial distribution of the cGMP-generating and cAMP-hydrolyzing proteins, as well as on the intracellular concentrations of the two cyclic nucleotides. Gaining a more precise understanding of how these cross-talk mechanisms are individually regulated and coordinated is an important direction for future research.

[1]  E. Lakatta,et al.  Activation of distinct cAMP-dependent and cGMP-dependent pathways by nitric oxide in cardiac myocytes. , 1999, Circulation research.

[2]  E. Degerman,et al.  Molecular cloning and expression of human myocardial cGMP-inhibited cAMP phosphodiesterase. , 1992, Proceedings of the National Academy of Sciences of the United States of America.

[3]  J. Scott,et al.  Compartmentalisation of phosphodiesterases and protein kinase A: opposites attract , 2005, FEBS letters.

[4]  A. Ketat,et al.  Sildenafil citrate increases myocardial cGMP content in rat heart, decreases its hypertrophic response to isoproterenol and decreases myocardial leak of creatine kinase and troponin T , 2005, BMC pharmacology.

[5]  H. C. Hartzell,et al.  Rate-limiting steps in the beta-adrenergic stimulation of cardiac calcium current , 1993, The Journal of general physiology.

[6]  L. Silengo,et al.  PI3Kγ Modulates the Cardiac Response to Chronic Pressure Overload by Distinct Kinase-Dependent and -Independent Effects , 2004, Cell.

[7]  Q. Yang,et al.  A novel cyclic GMP stimulated phosphodiesterase from rat brain. , 1994, Biochemical and biophysical research communications.

[8]  M. Zaccolo,et al.  Compartmentalisation of cAMP and Ca(2+) signals. , 2002, Current opinion in cell biology.

[9]  A. Shah,et al.  Role of cyclic GMP‐dependent protein kinase in the contractile response to exogenous nitric oxide in rat cardiac myocytes , 2002, The Journal of physiology.

[10]  D. Kass,et al.  Chronic inhibition of cyclic GMP phosphodiesterase 5A prevents and reverses cardiac hypertrophy , 2005, Nature Medicine.

[11]  E. Degerman,et al.  Cyclic Nucleotide Phosphodiesterases (PDEs): Diverse Regulators of Cyclic Nucleotide Signals and Inviting Molecular Targets for Novel Therapeutic Agents , 1999, Thrombosis and Haemostasis.

[12]  J. Corbin,et al.  Cyclic nucleotide phosphodiesterases: relating structure and function. , 2001, Progress in nucleic acid research and molecular biology.

[13]  R. Ritchie,et al.  Antihypertrophic actions of the natriuretic peptides in adult rat cardiomyocytes: importance of cyclic GMP. , 2003, Cardiovascular research.

[14]  E. Degerman,et al.  Identification of a novel isoform of the cyclic-nucleotide phosphodiesterase PDE3A expressed in vascular smooth-muscle myocytes. , 2001, The Biochemical journal.

[15]  R. Sharma,et al.  Calmodulin-dependent cyclic nucleotide phosphodiesterase (PDE1) , 1999, Cellular and Molecular Life Sciences CMLS.

[16]  M. Zaccolo,et al.  Restricted diffusion of a freely diffusible second messenger: mechanisms underlying compartmentalized cAMP signalling. , 2006, Biochemical Society transactions.

[17]  D. Garbers,et al.  A genetic model provides evidence that the receptor for atrial natriuretic peptide (guanylyl cyclase-A) inhibits cardiac ventricular myocyte hypertrophy , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[18]  V. Manganiello,et al.  Isoforms of Cyclic Nucleotide Phosphodiesterase PDE3 and Their Contribution to cAMP Hydrolytic Activity in Subcellular Fractions of Human Myocardium* , 2005, Journal of Biological Chemistry.

[19]  M. Mumby,et al.  Purification and characterization of a cyclic GMP-stimulated cyclic nucleotide phosphodiesterase from bovine tissues. , 1982, The Journal of biological chemistry.

[20]  D. Cooper,et al.  Cyclic Guanosine Monophosphate Compartmentation in Rat Cardiac Myocytes , 2006, Circulation.

[21]  M. Houslay,et al.  Altered expression of PDE1 and PDE4 cyclic nucleotide phosphodiesterase isoforms in 7-oxo-prostacyclin-preconditioned rat heart. , 1997, Journal of molecular and cellular cardiology.

[22]  E. Degerman,et al.  Functions of the N-terminal Region of Cyclic Nucleotide Phosphodiesterase 3 (PDE 3) Isoforms* , 2000, The Journal of Biological Chemistry.

[23]  K. Ferguson,et al.  Isolation and characterization of human cDNAs encoding a cGMP-stimulated 3',5'-cyclic nucleotide phosphodiesterase. , 1997, Gene.

[24]  L. Brunton,et al.  Compartments of cyclic AMP and protein kinase in mammalian cardiomyocytes. , 1983, The Journal of biological chemistry.

[25]  J. Balligand,et al.  Nitric oxide synthase (NOS3)-mediated cholinergic modulation of Ca2+ current in adult rabbit atrioventricular nodal cells. , 1996, Circulation research.

[26]  W. Sessa,et al.  PKC&agr; Activates eNOS and Increases Arterial Blood Flow In Vivo , 2005 .

[27]  E. Kranias,et al.  Inotropic Responses to Isoproterenol and Phosphodiesterase Inhibitors in Intact Guinea Pig Hearts: Comparison of Cyclic AMP Levels and Phosphorylation of Sarcoplasmic Reticulum and Myofibrillar Proteins , 1989, Circulation research.

[28]  A. Zeiher,et al.  Fluid shear stress stimulates phosphorylation of Akt in human endothelial cells: involvement in suppression of apoptosis. , 1998, Circulation research.

[29]  Tullio Pozzan,et al.  Discrete Microdomains with High Concentration of cAMP in Stimulated Rat Neonatal Cardiac Myocytes , 2002, Science.

[30]  M. Zaccolo,et al.  cGMP Catabolism by Phosphodiesterase 5A Regulates Cardiac Adrenergic Stimulation by NOS3-Dependent Mechanism , 2004, Circulation research.

[31]  C. Hohl,et al.  Compartmentation of cAMP in adult canine ventricular myocytes. Relation to single-cell free Ca2+ transients. , 1991, Circulation research.

[32]  D. Cooper Regulation and organization of adenylyl cyclases and cAMP. , 2003, The Biochemical journal.

[33]  M. Conti Phosphodiesterases and cyclic nucleotide signaling in endocrine cells. , 2000, Molecular endocrinology.

[34]  P. Fisher,et al.  Phosphodiesterase-5 Inhibition With Sildenafil Attenuates Cardiomyocyte Apoptosis and Left Ventricular Dysfunction in a Chronic Model of Doxorubicin Cardiotoxicity , 2005, Circulation.

[35]  L. Langeberg,et al.  mAKAP assembles a protein kinase A/PDE4 phosphodiesterase cAMP signaling module , 2001, The EMBO journal.

[36]  B. Kobilka,et al.  Phosphodiesterase 4D is required for beta2 adrenoceptor subtype-specific signaling in cardiac myocytes. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[37]  R. Fischmeister,et al.  cGMP-stimulated cyclic nucleotide phosphodiesterase regulates the basal calcium current in human atrial myocytes. , 1997, The Journal of clinical investigation.

[38]  O. Brodde Beta-adrenoceptors in cardiac disease. , 1993, Pharmacology & therapeutics.

[39]  E. Degerman,et al.  Regulation and function of the cyclic nucleotide phosphodiesterase (PDE3) gene family. , 2001, Progress in nucleic acid research and molecular biology.

[40]  W. Sessa,et al.  PKCalpha activates eNOS and increases arterial blood flow in vivo. , 2005, Circulation research.

[41]  Anindita Das,et al.  Protein kinase C plays an essential role in sildenafil-induced cardioprotection in rabbits. , 2004, American journal of physiology. Heart and circulatory physiology.

[42]  J. Beavo,et al.  Cyclic Nucleotide Phosphodiesterases: Molecular Regulation to Clinical Use , 2006, Pharmacological Reviews.

[43]  L. Langeberg,et al.  The protein kinase A anchoring protein mAKAP coordinates two integrated cAMP effector pathways , 2005, Nature.

[44]  N. Klugbauer,et al.  Another member of the cyclic nucleotide-gated channel family, expressed in testis, kidney, and heart. , 1994, Proceedings of the National Academy of Sciences of the United States of America.

[45]  C. Deschepper,et al.  Expression of Constitutively Active Guanylate Cyclase in Cardiomyocytes Inhibits the Hypertrophic Effects of Isoproterenol and Aortic Constriction on Mouse Hearts* , 2003, Journal of Biological Chemistry.

[46]  J. Hell,et al.  Localization of cardiac L-type Ca(2+) channels to a caveolar macromolecular signaling complex is required for beta(2)-adrenergic regulation. , 2006, Proceedings of the National Academy of Sciences of the United States of America.

[47]  P. Ferdinandy,et al.  Effect of classic preconditioning on the gene expression pattern of rat hearts: a DNA microarray study , 2003, FEBS letters.

[48]  J. Corbin,et al.  Tissue distribution of phosphodiesterase families and the effects of sildenafil on tissue cyclic nucleotides, platelet function, and the contractile responses of trabeculae carneae and aortic rings in vitro. , 1999, The American journal of cardiology.

[49]  W. Giles,et al.  A cellular mechanism for nitric oxide-mediated cholinergic control of mammalian heart rate , 1995, The Journal of general physiology.

[50]  M. Conti,et al.  Short Term Feedback Regulation of cAMP in FRTL-5 Thyroid Cells , 2000, The Journal of Biological Chemistry.

[51]  F. Salloum,et al.  Sildenafil Induces Delayed Preconditioning Through Inducible Nitric Oxide Synthase–Dependent Pathway in Mouse Heart , 2003, Circulation research.

[52]  M. Kuhn,et al.  Structure, regulation, and function of mammalian membrane guanylyl cyclase receptors, with a focus on guanylyl cyclase-A. , 2003, Circulation research.

[53]  K. Omori,et al.  A Novel Interaction of cGMP-dependent Protein Kinase I with Troponin T* , 1999, The Journal of Biological Chemistry.

[54]  J. Bos,et al.  Epac proteins: multi-purpose cAMP targets. , 2006, Trends in biochemical sciences.

[55]  G. Booz Putting the brakes on cardiac hypertrophy: exploiting the NO-cGMP counter-regulatory system. , 2005, Hypertension.

[56]  R. Kass,et al.  Phosphorylation of the A-kinase-anchoring Protein Yotiao Contributes to Protein Kinase A Regulation of a Heart Potassium Channel* , 2005, Journal of Biological Chemistry.

[57]  F. Hofmann,et al.  The activation of expressed cGMP-dependent protein kinase isozymes I alpha and I beta is determined by the different amino-termini. , 1991, European journal of biochemistry.

[58]  É. Rousseau,et al.  Characterization of cyclic nucleotide phosphodiesterase isoforms associated to isolated cardiac nuclei. , 1999, Biochimica et biophysica acta.

[59]  C. Lugnier Cyclic nucleotide phosphodiesterase (PDE) superfamily: a new target for the development of specific therapeutic agents. , 2006, Pharmacology & therapeutics.

[60]  E. Fung,et al.  Adrenomedullin Induces Direct (Endothelium-independent) Vasorelaxations and Cyclic Adenosine Monophosphate Elevations that Are Synergistically Enhanced by Brain Natriuretic Peptide in Isolated Rings of Rat Thoracic Aorta , 2003, Journal of cardiovascular pharmacology.

[61]  C. Lugnier,et al.  Modulation of vascular cyclic nucleotide phosphodiesterases by cyclic GMP: role in vasodilatation. , 1993, European heart journal.

[62]  F. Hofmann,et al.  cGMP-Dependent Protein Kinase I Mediates the Negative Inotropic Effect of cGMP in the Murine Myocardium , 2002, Circulation research.

[63]  C. Dessauer,et al.  Soluble Adenylyl Cyclase Reveals the Significance of cAMP Compartmentation on Pulmonary Microvascular Endothelial Cell Barrier , 2006, Circulation research.

[64]  V. Coghlan,et al.  Identification of cGMP-dependent protein kinase anchoring proteins (GKAPs). , 1998, Biochemical and Biophysical Research Communications - BBRC.

[65]  J. Corbin,et al.  Binding of cGMP to both allosteric sites of cGMP-binding cGMP-specific phosphodiesterase (PDE5) is required for its phosphorylation. , 1998, The Biochemical journal.

[66]  A. Shah,et al.  Paracrine and autocrine effects of nitric oxide on myocardial function. , 2000, Pharmacology & therapeutics.

[67]  G. Hindricks,et al.  Polycystic disease of the kidneys complicating the diagnosis of myocardial echinococcosis. , 1993, European heart journal.

[68]  J. Balligand,et al.  Control of cardiac muscle cell function by an endogenous nitric oxide signaling system. , 1993, Proceedings of the National Academy of Sciences of the United States of America.

[69]  D. Kass,et al.  Cardiac phosphodiesterase 5 (cGMP‐specific) modulates β‐adrenergic signaling in vivo and is down‐regulated in heart failure , 2001, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[70]  R. Fischmeister,et al.  Cyclic GMP regulation of the L‐type Ca2+ channel current in human atrial myocytes , 2001, The Journal of physiology.

[71]  R Fischmeister,et al.  cAMP compartmentation is responsible for a local activation of cardiac Ca2+ channels by beta-adrenergic agonists. , 1996, Proceedings of the National Academy of Sciences of the United States of America.

[72]  Xiaodong Cheng,et al.  Fluorescent indicators of cAMP and Epac activation reveal differential dynamics of cAMP signaling within discrete subcellular compartments. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[73]  P. Pattanaik,et al.  Structural insights into the regulation and the activation mechanism of mammalian guanylyl cyclases. , 2004, Pharmacology & therapeutics.

[74]  Roger Y. Tsien,et al.  Insulin disrupts β-adrenergic signalling to protein kinase A in adipocytes , 2005, Nature.

[75]  C. Trautwein,et al.  Gene Transfer of cGMP-Dependent Protein Kinase I Enhances the Antihypertrophic Effects of Nitric Oxide in Cardiomyocytes , 2002, Hypertension.

[76]  Suhn Hee Kim,et al.  High and Low Gain Switches for Regulation of cAMP Efflux Concentration: Distinct Roles for Particulate GC- and Soluble GC-cGMP-PDE3 Signaling in Rabbit Atria , 2004, Circulation research.

[77]  M. Conti,et al.  Protein kinase B/Akt phosphorylation of PDE3A and its role in mammalian oocyte maturation , 2006, The EMBO journal.

[78]  Nicola Elvassore,et al.  PGE1 stimulation of HEK293 cells generates multiple contiguous domains with different [cAMP]: role of compartmentalized phosphodiesterases , 2006, The Journal of cell biology.

[79]  F. Hofmann,et al.  Regulation of cGMP-specific Phosphodiesterase (PDE5) Phosphorylation in Smooth Muscle Cells* , 2002, The Journal of Biological Chemistry.

[80]  M. Zaugg,et al.  Integration of calcium with the signaling network in cardiac myocytes. , 2006, Journal of molecular and cellular cardiology.

[81]  Y. Shintani,et al.  Potentiation of slow component of delayed rectifier K+ currentby cGMP via two distinct mechanisms: inhibition of phosphodiesterase 3 and activation of protein kinase G , 2002, British journal of pharmacology.

[82]  U. Walter,et al.  Increased effects of C‐type natriuretic peptide on contractility and calcium regulation in murine hearts overexpressing cyclic GMP‐dependent protein kinase I , 2003, British journal of pharmacology.

[83]  J. Abe,et al.  Role of Phosphodiesterase 3 in NO/cGMP-Mediated Antiinflammatory Effects in Vascular Smooth Muscle Cells , 2003, Circulation research.

[84]  F. Fouque,et al.  Activation of a cGMP-stimulated cAMP phosphodiesterase by protein kinase C in a liver Golgi-endosomal fraction. , 2001, European journal of biochemistry.

[85]  J. Beavo,et al.  The Calmodulin-dependent Phosphodiesterase Gene PDE1C Encodes Several Functionally Different Splice Variants in a Tissue-specific Manner* , 1996, The Journal of Biological Chemistry.

[86]  M. Zaccolo,et al.  Compartmentalized Phosphodiesterase-2 Activity Blunts &bgr;-Adrenergic Cardiac Inotropy via an NO/cGMP-Dependent Pathway , 2006, Circulation research.

[87]  S. Jin,et al.  Myomegalin Is a Novel Protein of the Golgi/Centrosome That Interacts with a Cyclic Nucleotide Phosphodiesterase* , 2001, The Journal of Biological Chemistry.

[88]  Anindita Das,et al.  Phosphodiesterase-5 Inhibitor Sildenafil Preconditions Adult Cardiac Myocytes against Necrosis and Apoptosis , 2005, Journal of Biological Chemistry.

[89]  G. Livera,et al.  Phosphodiesterase 4D Forms a cAMP Diffusion Barrier at the Apical Membrane of the Airway Epithelium* , 2005, Journal of Biological Chemistry.

[90]  M. Lohse,et al.  Cyclic AMP Imaging in Adult Cardiac Myocytes Reveals Far-Reaching &bgr;1-Adrenergic but Locally Confined &bgr;2-Adrenergic Receptor–Mediated Signaling , 2006, Circulation research.

[91]  R Fischmeister,et al.  Nitric oxide regulates cardiac Ca2+ current. Involvement of cGMP-inhibited and cGMP-stimulated phosphodiesterases through guanylyl cyclase activation. , 1993, The Journal of biological chemistry.

[92]  J. Beavo,et al.  Cloning and characterization of a cAMP-specific cyclic nucleotide phosphodiesterase. , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[93]  V. Ferrans,et al.  Membrane Localization of Cyclic Nucleotide Phosphodiesterase 3 (PDE3) , 2000, The Journal of Biological Chemistry.

[94]  M. Houslay,et al.  In addition to the SH3 binding region, multiple regions within the N-terminal noncatalytic portion of the cAMP-specific phosphodiesterase, PDE4A5, contribute to its intracellular targeting. , 2002, Cellular signalling.

[95]  V. Manganiello,et al.  Molecular cloning of the rat adipocyte hormone-sensitive cyclic GMP-inhibited cyclic nucleotide phosphodiesterase. , 1993, The Journal of biological chemistry.

[96]  K. Sadhu,et al.  Isolation and Characterization of cDNAs Corresponding to Two Human Calcium, Calmodulin-regulated, 3′,5′-Cyclic Nucleotide Phosphodiesterases (*) , 1996, The Journal of Biological Chemistry.

[97]  Roger Y Tsien,et al.  Insulin disrupts beta-adrenergic signalling to protein kinase A in adipocytes. , 2005, Nature.

[98]  J. Beavo,et al.  Stimulation of adenosine 3',5'-monophosphate hydrolysis by guanosine 3',5'-monophosphate. , 1971, The Journal of biological chemistry.

[99]  M. Houslay A RSK(y) Relationship with Promiscuous PKA , 2006, Science's STKE.

[100]  W. Sessa eNOS at a glance , 2004, Journal of Cell Science.

[101]  F. Hofmann,et al.  The activation of expressed cGMP‐dependent protein kinase isozymes Iα and Iβ is determined by the different amino‐termini , 1991 .

[102]  J. Beavo,et al.  High concentrations of a cGMP-stimulated phosphodiesterase mediate ANP-induced decreases in cAMP and steroidogenesis in adrenal glomerulosa cells. , 1991, The Journal of biological chemistry.

[103]  J. Schaack,et al.  In Vivo Assessment of Local Phosphodiesterase Activity Using Tailored Cyclic Nucleotide–Gated Channels as Camp Sensors , 2001, The Journal of general physiology.

[104]  M. Houslay,et al.  Rapid regulation of PDE-2 and PDE-4 cyclic AMP phosphodiesterase activity following ligation of the T cell antigen receptor on thymocytes: analysis using the selective inhibitors erythro-9-(2-hydroxy-3-nonyl)-adenine (EHNA) and rolipram. , 1996, Cellular signalling.

[105]  Joao A. C. Lima,et al.  Nitric oxide regulates the heart by spatial confinement of nitric oxide synthase isoforms , 2002, Nature.

[106]  W. Hol,et al.  GAF domains: two-billion-year-old molecular switches that bind cyclic nucleotides. , 2002, Molecular interventions.

[107]  S. Reiken,et al.  Phosphodiesterase 4D Deficiency in the Ryanodine-Receptor Complex Promotes Heart Failure and Arrhythmias , 2005, Cell.

[108]  C. Roberts,et al.  Atrial Natriuretic Peptide Induces Natriuretic Peptide Receptor-cGMP-dependent Protein Kinase Interaction* , 2003, Journal of Biological Chemistry.

[109]  L. Brunton,et al.  Cellular distribution of phosphodiesterase isoforms in rat cardiac tissue. , 1991, Circulation Research.

[110]  M. Houslay,et al.  PDE4 cAMP phosphodiesterases: modular enzymes that orchestrate signalling cross-talk, desensitization and compartmentalization. , 2003, The Biochemical journal.

[111]  W. K. Sonnenburg,et al.  Molecular cloning of a cyclic GMP-stimulated cyclic nucleotide phosphodiesterase cDNA. Identification and distribution of isozyme variants. , 1991, The Journal of biological chemistry.

[112]  J. Knowles,et al.  Pressure-independent enhancement of cardiac hypertrophy in natriuretic peptide receptor A-deficient mice. , 2001, The Journal of clinical investigation.

[113]  L. Brunton,et al.  Functional compartmentation of cyclic AMP and protein kinase in heart. , 1981, Advances in cyclic nucleotide research.

[114]  V Avdonin,et al.  A beta2 adrenergic receptor signaling complex assembled with the Ca2+ channel Cav1.2. , 2001, Science.

[115]  John D. Scott,et al.  AKAP signalling complexes: focal points in space and time , 2004, Nature Reviews Molecular Cell Biology.

[116]  M. Zaccolo,et al.  Imaging Signal Transduction in Living Cells with GFP‐Based Probes , 2000, IUBMB life.

[117]  Y. Furukawa,et al.  C-type natriuretic peptide increases myocardial contractility and sinus rate mediated by guanylyl cyclase-linked natriuretic peptide receptors in isolated, blood-perfused dog heart preparations. , 1998, The Journal of pharmacology and experimental therapeutics.

[118]  V. Manganiello,et al.  Isoforms of Cyclic Nucleotide Phosphodiesterase PDE3A in Cardiac Myocytes* , 2002, The Journal of Biological Chemistry.

[119]  M. Silberbach,et al.  Natriuretic Peptides and Nitric Oxide Stimulate cGMP Synthesis in Different Cellular Compartments , 2006, The Journal of general physiology.

[120]  H. Drexler,et al.  Inhibition of calcineurin-NFAT hypertrophy signaling by cGMP-dependent protein kinase type I in cardiac myocytes , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[121]  D. Cooper,et al.  A Specific Pattern of Phosphodiesterases Controls the cAMP Signals Generated by Different Gs-Coupled Receptors in Adult Rat Ventricular Myocytes , 2006, Circulation research.

[122]  S. Lohmann,et al.  Increased effects of C-type natriuretic peptide on cardiac ventricular contractility and relaxation in guanylyl cyclase A-deficient mice. , 2002, Cardiovascular research.

[123]  Martin J. Lohse,et al.  Fluorescence Resonance Energy Transfer–Based Analysis of cAMP Dynamics in Live Neonatal Rat Cardiac Myocytes Reveals Distinct Functions of Compartmentalized Phosphodiesterases , 2004, Circulation research.

[124]  Pierre L. Page,et al.  Positive chronotropic and inotropic effects of C-type natriuretic peptide in dogs. , 1997, The American journal of physiology.