natriuretic-peptide--c-type and Myocarditis

We evaluated the influence of inflammation on cardiac endocrine function in autoimmune rheumatic disease (RD) patients with preserved left ventricular systolic function.. 160 consecutive RD patients (29 males, age 55 ± 14 years, left ventricular ejection fraction, LVEF, 63 ± 5%: inflammatory polyarthritis: 13%, systemic sclerosis: 25%, connective tissue diseases: 39%, systemic vasculitides: 23%) and 120 healthy controls (24 males, 55 ± 10 years) underwent clinical, echocardiographic evaluation and blood sampling for erythrocyte sedimentation rate, C-reactive protein (CRP), fibrinogen and plasma NT-proBNP.. A significant correlation was found between plasma NT-proBNP and inflammatory markers (all p<0.001), with CRP and diastolic dysfunction being the only independent predictors of NT-proBNP level. RD patients with active disease (57%) showed higher values of inflammatory markers and NT-proBNP (all p<0.01). Patients with subclinical cardiac involvement (Stage B by ACC/AHA HF-classification) had higher NT-proBNP (p<0.001) than controls and patients only at risk for HF (Stage A). NT-proBNP showed a significant diagnostic accuracy in discriminating stage B (n=93) versus stage A patients (n=67, AUC=0.755 ± 0.038, p<0.001) and controls (AUC=0.834 ± 0.030, p<0.001).. Higher CRP and the presence of left ventricular diastolic dysfunction were independently associated with higher NT-proBNP. NT-proBNP might be used in RD as a marker of both disease activity and subclinical cardiac involvement.

Topics: Adult; Aged; Autoimmune Diseases; Biomarkers; Blood Sedimentation; C-Reactive Protein; Early Diagnosis; Female; Fibrinogen; Humans; Male; Middle Aged; Myocarditis; Natriuretic Peptide, C-Type; Predictive Value of Tests; Rheumatic Diseases

Myocarditis is an acute inflammatory disease of the myocardium for which there is currently no specific therapy. We investigated the therapeutic potential of C-type natriuretic peptide (CNP) in acute experimental autoimmune myocarditis. One week after injection of porcine myosin into male Lewis rats, CNP (0.05 microg/kg/min) was continuously administered for 2 weeks. CNP infusion significantly increased maximum dP/dt, decreased left ventricular end-diastolic pressure, and improved fractional shortening compared with vehicle administration. In vehicle-treated hearts, severe necrosis and marked infiltration of CD68-positive inflammatory cells were observed. Myocardial and serum levels of monocyte chemoattractant protein-1 were elevated in myocarditis. However, these changes were attenuated by CNP infusion. In addition, treatment with CNP significantly increased myocardial capillary density. Guanylyl cyclase-B, a receptor for CNP, was expressed in myocarditic heart, and cyclic guanosine monophosphate was elevated by CNP infusion. In conclusion, CNP infusion attenuated cardiac function in acute myocarditis through anti-inflammatory and angiogenic effects.

Topics: Animals; Blood Pressure; Blood Vessels; Chemokine CCL2; Cyclic GMP; Enzyme-Linked Immunosorbent Assay; Guanylate Cyclase; Heart; Heart Rate; Inflammation; Male; Myocarditis; Myocardium; Natriuretic Agents; Natriuretic Peptide, C-Type; Radioimmunoassay; Rats; Rats, Inbred Lew; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Swine; Ultrasonography; von Willebrand Factor