Does the C-Type Natriuretic Peptide Have Prognostic Value in Chagas Disease and Other Dilated Cardiomyopathies?

Atrial natriuretic peptides (ANP) and brain natriuretic peptides (BNP) are powerful neurohormonal indicators of left-ventricular function and prognosis in heart failure (HF). Chagas disease (CD) caused by the protozoan Trypanosoma cruzi remains a major cause of HF in Latin America. We assessed whether the plasma concentration of the third natriuretic peptide, C-type natriuretic peptide (CNP), also has diagnostic and prognostic properties in patients with CD or other dilated cardiomyopathies (DCM). Blood samples were obtained from 66 patients with CD, 50 patients with DCM from other causes, and 30 gender- and age-matched healthy subjects. Patients were subdivided according to the New York Heart Association (NYHA) class. The CNP concentration was determined by radioimmunoassay (Immundiagnostik, Bensheim, Germany). The main duration of follow-up was 31.4 months (range 13 to 54 months); 19 patients had died and 11 patients received a heart transplant. CNP concentrations were only significantly altered in patients with DCM or CD of the NYHA classes III and IV (P < 0.05). The Pearson correlation of echocardiographic data with CNP revealed an association only with the left-ventricular end systolic volume (P = 0.03) in patients with DCM. Furthermore, CNP did not predict mortality or the necessity for heart transplant. Our data are the first to demonstrate the raised levels of the third natriuretic peptide CNP in CD and other DCM. Whereas ANP and BNP have a high predictive value for mortality in both diseases, CNP is without any predictive potency.

[1]  Pedro Lozano.  Natriuretic peptides. , 2020, The Journal of the Arkansas Medical Society.

[2]  J. Towbin,et al.  B-Type Natriuretic Peptide Predicts Adverse Cardiovascular Events in Pediatric Outpatients With Chronic Left Ventricular Systolic Dysfunction , 2006, Circulation.

[3]  T. Lancet.  Chagas' disease—an epidemic that can no longer be ignored , 2006, The Lancet.

[4]  A. Hasslocher-Moreno,et al.  Development and validation of a risk score for predicting death in Chagas' heart disease. , 2006, The New England journal of medicine.

[5]  H. Yeh,et al.  Brain natriuretic peptide and C-type natriuretic peptide are differently regulated by age but similarly elevated in coronary artery disease , 2006, Acta cardiologica.

[6]  M. Emdin,et al.  C‐type natriuretic peptide plasma levels increase in patients with chronic heart failure as a function of clinical severity , 2005, European journal of heart failure.

[7]  J. Ornato,et al.  ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article , 2005 .

[8]  Karl Swedberg,et al.  Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. , 2005, European heart journal.

[9]  A. Hoes,et al.  Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. , 2005, European heart journal.

[10]  T. Walther,et al.  Brain natriuretic peptide predicts survival in Chagas’ disease more effectively than atrial natriuretic peptide , 2005, Heart.

[11]  R. Doughty,et al.  Amino-Terminal Pro–C-Type Natriuretic Peptide in Heart Failure , 2004 .

[12]  Martin Metzger,et al.  Pathophysiology of the heart in Chagas' disease: current status and new developments. , 2003, Cardiovascular research.

[13]  R. Doughty,et al.  Amino-terminal pro-C-type natriuretic peptide in heart failure. , 2003, Hypertension.

[14]  T. Maki,et al.  Gene expression, secretion, and autocrine action of C-type natriuretic peptide in cultured adult rat cardiac fibroblasts. , 2003, Endocrinology.

[15]  T. Walther,et al.  Brain natriuretic peptide as a predictor of cardiomyopathy in Chagas' disease , 2003, The Lancet.

[16]  A. Ribeiro,et al.  Brain natriuretic peptide and left ventricular dysfunction in Chagas' disease , 2002, The Lancet.

[17]  R. Berger,et al.  B-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure , 2002, Circulation.

[18]  B. Fernández,et al.  Atrial natriuretic factor as marker of myocardial compromise in Chagas' disease , 2002, Regulatory Peptides.

[19]  A. Richards,et al.  Identification of amino-terminal pro-C-type natriuretic peptide in human plasma. , 2001, Biochemical and biophysical research communications.

[20]  K. Nakao,et al.  Dwarfism and early death in mice lacking C-type natriuretic peptide , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[21]  T. Walther,et al.  Organ-specific mRNA distribution of C-type natriuretic peptide in neonatal and adult mice , 2000, Regulatory Peptides.

[22]  T. Walther,et al.  Opposite regulation of brain and C-type natriuretic peptides in the streptozotocin-diabetic cardiopathy. , 2000, Journal of molecular endocrinology.

[23]  J. Burnett,et al.  Natriuretic peptides in the pathophysiology of congestive heart failure , 2000, Current cardiology reports.

[24]  T. Walther,et al.  C-type natriuretic peptide levels in women with gestational hypertension and preeclampsia. , 1999, Obstetrics and gynecology.

[25]  H. Itoh,et al.  Detection of C-type natriuretic peptide in human circulation and marked increase of plasma CNP level in septic shock patients. , 1994, Biochemical and biophysical research communications.

[26]  W. Edwards,et al.  Natriuretic peptide system in human heart failure. , 1993, Circulation.

[27]  K. Hosoda,et al.  C-type natriuretic peptide (CNP) in rats and humans. , 1991, Endocrinology.

[28]  S. Anker,et al.  Myocardial production of C-type natriuretic peptide in chronic heart failure. , 2003, Circulation.

[29]  H. H. Chen,et al.  C-type natriuretic peptide: the endothelial component of the natriuretic peptide system. , 1998, Journal of cardiovascular pharmacology.