HOW DOES TREATMENT INFLUENCE ENDOCRINE MECHANISMS IN ACUTE SEVERE HEART-FAILURE - EFFECTS ON CARDIAC NATRIURETIC PEPTIDES, THE RENIN SYSTEM, NEUROPEPTIDE-Y AND CATECHOLAMINES

1. Hormones involved in cardiovascular regulation are influenced by dr ug treatment. It is therefore difficult to study endocrine mechanisms in heart failure as most patients are already on treatment by the time they reach hospital, 2. We studied nine hospital in-patients before a nd after treatment of acute New York Heart Association class IV heart failure. 3. Before treatment, plasma brain and atrial natriuretic pept ides were markedly elevated (BNP 121 +/- 26 pg/ml, ANP 163 +/- 33 pg/m l; normal range: BNP 3.9 +/- 0.3 pg/ml, ANP 8.6 +/- 0.8 pg/ml) and cor related positively with serum creatinine and left ventricular end-dias tolic diameter and negatively with ejection fraction. Eight patients i mproved and one died, 4. With improvement plasma ANP and BNP fell. Ini tial renin activity was within the normal range but increased on treat ment, Plasma neuropeptide Y and adrenaline remained normal before and after treatment in the eight patients who improved, Initial plasma nor adrenaline was in the normal range in four of these patients and just above normal in a further four. In the patient who died, initial plasm a neuropeptide Y and catecholamines were very high. 5. Plasma BNP emer ged as complementary to ANP as a dynamic index in severe heart failure ; however, renal function is also an important determinant of plasma B NP and ANP, There is little evidence for activation of the circulating renin-angiotensin-aldosterone system or neuropeptide Y before treatme nt of acute heart failure.