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Intact negative feedback of four cardiac hormones in congestive heart failure
David L Vesely1, Gloria I San Miguel, Imran Hassan
1Department of Internal Medicine, Cardiac Hormone Center, University of South Florida Health Sciences Center, Tampa, FL 33612, USA.
Insights
Cardiac peptide hormones, including long-acting natriuretic peptide (LANP) and atrial natriuretic factor (ANF), exhibit negative feedback in heart failure patients. This regulation is preserved despite elevated hormone levels in congestive heart failure (CHF).
Area of Science:
- Cardiology
- Endocrinology
- Physiology
Background:
- Congestive heart failure (CHF) is associated with altered cardiac peptide hormone levels.
- Understanding the regulatory mechanisms of these hormones is crucial for managing CHF.
Purpose of the Study:
- To investigate the negative feedback regulation among four cardiac peptide hormones in individuals with Class III CHF.
- To determine if the feedback mechanisms observed in healthy individuals are maintained in CHF patients.
Main Methods:
- Infusion of individual cardiac hormones (long-acting natriuretic peptide [LANP], vessel dilator, kaliuretic peptide, atrial natriuretic factor [ANF]) and saline control in 30 CHF patients.
- Measurement of circulating concentrations and urinary excretion of these hormones before and after infusions.
Main Results:
- Each infused cardiac hormone significantly decreased circulating levels of the other three hormones.
- Infusion of each hormone also reduced the urinary excretion of the other three.
- Observed decreases ranged from 11% to 98%.
Conclusions:
- Cardiac peptide hormones appear to inhibit each other's release, not their breakdown, in CHF patients.
- The negative feedback regulation of these hormones is preserved in CHF, despite elevated endogenous levels.
- This preserved feedback suggests a conserved regulatory system in the failing heart.
Abstract:
In 30 individuals with class III congestive heart failure (CHF), negative feedback of 4 cardiac peptide hormones, ie, long-acting natriuretic peptide (LANP), vessel dilator, kaliuretic peptide, and atrial natriuretic factor (ANF) from the same 126-amino acid (aa) prohormone were studied with the infusion of 100 ng/kg body weight (BW) for 60 minutes of each of the 4 cardiac hormones and a saline control (n = 6 for each). LANP decreased the circulating concentrations of vessel dilator, kaliuretic peptide, and ANF by 24%, 55%, and 30%, respectively. Vessel dilator decreased the circulating concentrations of ANF, kaliuretic peptide, and LANP 27%, 12%, and 62%, respectively. Kaliuretic peptide decreased the circulating concentrations of LANP, ANF, and vessel dilator 89%, 67%, and 70%, respectively. ANF decreased the circulating concentrations of LANP, vessel dilator, and kaliuretic peptide 88%, 59%, and 98%, respectively. Infusion of each of these 4 cardiac hormones decreased the excretion of the other 3 hormones into the urine by 11% to 92%. These results suggest that the respective cardiac hormones inhibit the release of each other rather than their breakdown, which would have increased their urinary concentrations. The feedback regulation of these hormones found previously in healthy humans is, thus, preserved in persons with CHF despite their increased endogenous circulating concentrations.
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