Early expression of natriuretic peptides and SERCA in mild heart failure

Background: We investigated changes in genetic expression of atrial and brain natriuretic peptides (ANP and BNP) and sarcoplasmic reticulum Ca 2+ -ATPase (SERCA) in patients with stable mild to moderate chronic heart failure (CHF), since data on this topic were primarily obtained in end-stage CHF. Methods: We studied tissue from 25 patients with idiopathic dilated cardiomyopathy (IDC) in New York Heart Association (NYHA) class II ( n =12) and III–IV ( n =13). Myocardial tissue from normal hearts ( n =10) served as controls. Messenger RNA (mRNA) expression of ANP, BNP, and SERCA was isolated, and correlated with severity of CHF, left ventricular function (LVEF), peak oxygen uptake (peak VO 2 ), and wedge pressure. Results: A significant trend for gradual changes in mRNA expression according to increasing NYHA class was found for ANP, BNP ( P P =0.04), with a marked increase in patients with more advanced CHF (ANP and BNP: P P 2 (−0.625 and −0.555, respectively, both P P P 2 were found. Conclusions: Genetic expression of ANP, BNP, and SERCA is progressively altered in proportion to the severity of CHF, although this is more marked for ANP and to a lesser extent BNP, than for SERCA. These changes support the concept that already early in CHF, genetic expression is affected, which has implications for the understanding of the pathophysiology of CHF.