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B-type natriuretic peptide levels and benign adiposity in obese heart failure patients

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Abstract

Obesity is a major risk factor for the development of chronic heart failure (CHF) and does not only pose diagnostic challenges, but also has prognostic implications for these patients. Paradoxically, obese patients with CHF have a better prognosis than thinner individuals. In recent years, it has been demonstrated that the adipose tissue, even in patients with HF, is not always detrimental, and that obesity may coexist with a phenotype of benign adiposity without systemic metabolic abnormalities. Experimental data have shown that natriuretic peptides (NPs), and in particular brain natriuretic peptide (BNP), play a major role in the communication of the heart with the adipose tissue. Body fat distribution and adipose tissue function show a large degree of heterogeneity among depots and may explain the complex relationship between NPs and body fat. NPs can affect both the quality and the behaviour of fatty tissue, promoting a healthy adipocyte phenotype, and can favourably affect body fat metabolism. In this article, we review the existing literature on the bidirectional effects of BNP and adipose tissue in HF and highlight the complexity of this relationship.

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References

  1. Rosenweig A, Seudeman CE (1991) Atrial natriuretic factor and related peptide hormones. Annu Rev Biochem 60:229–255

    Article  Google Scholar 

  2. Hunt PJ, Espiner EA, Nicholis MG, Richards AM, Yandl TG (1996) Differing biological effects of equimolar atrial and brain natriuretic peptide infusion in normal man. J Clin Endocrinol Metab 81:3871–3876

    CAS  PubMed  Google Scholar 

  3. Antonopoulos AS, Margaritis M, Coutinho P, Digby J, Patel R, Psarros C, Ntusi N, Karamitsos TD, Lee R, de Silva R, Petrou M, Sayeed R, Demosthenous M, Bakogiannis C, Wordsworth PB, Tousoulis D, Neubauer S, Channon KM, Antoniades C (2014) Reciprocal effects of systemic inflammation and brain natriuretic peptide on adiponectin biosynthesis in adipose tissue of patients with ischemic heart disease. Arterioscler Thromb Vasc Biol 34:2151–2159

    Article  CAS  PubMed  Google Scholar 

  4. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members, Document Reviewers (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975

    Article  PubMed  Google Scholar 

  5. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, PARADIGM-HF Investigators and Committees (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004

    Article  CAS  PubMed  Google Scholar 

  6. Lauer MS, Anderson KM, Kannel WB, Levy D (1991) The impact of obesity on left ventricular mass and geometry: the Framingham Heart Study. JAMA 266:231–236

    Article  CAS  PubMed  Google Scholar 

  7. Schunkert H (2002) Obesity and target organ damage: the heart. Int J Obes 26:S15–S20

    Article  Google Scholar 

  8. Kenchaiah S, Evans JC, Levy D, Wilson PWF, Benjamin EJ, Larson MG, Kannel WB, Vasan RS (2002) Obesity and the risk of heart failure. N Engl J Med 347:305–313

    Article  PubMed  Google Scholar 

  9. von Haehling S, Anker SD (2014) Prevalence, incidence and clinical impact of cachexia: facts and numbers—update 2014. J Cachexia Sarcopenia Muscle 5:261–263

    Article  Google Scholar 

  10. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, Jatoi A, Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D, Wolfe R, Anker SD (2008) Cachexia: a new definition. Clin Nutr 27:793–799

    Article  CAS  PubMed  Google Scholar 

  11. Coelho M, Oliveira T, Fernandes R (2013) Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci 9:191–200

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ouwens DM, Sell H, Greulich S, Eckel J (2010) The role of epicardial and perivascular adipose tissue in the pathophysiology of cardiovascular disease. J Cell Mol Med 14:2223–2234

    Article  PubMed  PubMed Central  Google Scholar 

  13. Madamanchi C, Alhosaini H, Sumida A, Runge MS (2014) Obesity and natriuretic peptides, BNP and NT-proBNP: mechanisms and diagnostic implications for heart failure. Int J Cardiol 176:611–617

    Article  PubMed  PubMed Central  Google Scholar 

  14. Harms M, Seale P (2013) Brown and beige fat: development, function and therapeutic potential. Nat Med 19:1252–1263

    Article  CAS  PubMed  Google Scholar 

  15. Bordicchia M, Liu D, Amri EZ, Ailhaud G, Dessì-Fulgheri P, Zhang C, Takahashi N, Sarzani R, Collins S (2012) Cardiac natriuretic peptides act via p38 MAPK to induce the brown fat thermogenic program in mouse and human adipocytes. J Clin Invest 122:1022–1036

    Article  PubMed  PubMed Central  Google Scholar 

  16. Maack T (2006) The broad homeostatic role of natriuretic peptides. Arq Bras Endocrinol Metabol 50:198–207

    Article  PubMed  Google Scholar 

  17. Sarzani R, Dessi-Fulgheri P, Paci VM, Espinosa E, Rappelli A (1996) Expression of natriuretic peptide receptors in human adipose and other tissues. J Endocrinol Investig 19:581–585

    Article  CAS  Google Scholar 

  18. Fu S, Ping P, Wang F, Luo L (2018) Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure. J Biol Eng 12:2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sengenes C, Stich V, Berlan M, Hejnova J, Lafontan M, Pariskova Z, Galitzky J (2002) Increased lipolysis in adipose tissue and lipid mobilization to natriuretic peptides during low-calorie diet in obese women. Int J Obes Relat Metab Disord 26:24–32

    Article  CAS  PubMed  Google Scholar 

  20. Bartelt A, Heeren J (2014) Adipose tissue browning and metabolic health. Nat Rev Endocrinol 10:24–36

    Article  CAS  PubMed  Google Scholar 

  21. Wankhade UD, Shen M, Yadav H, Thakali KM (2016) Novel browning agents, mechanisms, and therapeutic potentials of brown adipose tissue. Biomed Res Int 2016:2365609

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Sengenes C, Berlan M, De Glisezinski I, Lafontan M, Galitzky J (2000) Natriuretic peptides: a new lipolytic pathway in human adipocytes. FASEB J 14:1345–1351

    Article  CAS  PubMed  Google Scholar 

  23. Tsukamoto O, Fujita M, Kato M, Yamazaki S, Asano Y, Ogai A, Okazaki H, Asai M, Nagamachi Y, Maeda N, Shintani Y, Minamino T, Asakura M, Kishimoto I, Funahashi T, Tomoike H, Kitakaze M (2009) Natriuretic peptides enhance the production of adiponectin in human adipocytes and in patients with chronic heart failure. J Am Coll Cardiol 53:2070–2077

    Article  CAS  PubMed  Google Scholar 

  24. Antoniades C, Mussa S, Shirodaria C, Lee J, Diesch J, Taggart DP, Channon KM, Leeson P (2009) Relation of preoperative radial artery flow-mediated dilatation to nitric oxide bioavailability in radial artery grafts used in off-pump coronary artery bypass grafting. Am J Cardiol 103:216–220

    Article  CAS  PubMed  Google Scholar 

  25. Han SH, Quon MJ, Kim JA, Koh KK (2007) Adiponectin and cardiovascular disease: response to therapeutic interventions. J Am Coll Cardiol 49:531–538

    Article  CAS  PubMed  Google Scholar 

  26. Han SH, Sakuma I, Shin EK, Koh KK (2009) Antiatherosclerotic and anti-insulin resistance effects of adiponectin: basic and clinical studies. Prog Cardiovasc Dis 52:126–140

    Article  CAS  PubMed  Google Scholar 

  27. Chandran M, Phillips SA, Ciaraldi T, Henry RR (2003) Adiponectin: more than just another fat cell hormone? Diabetes Care 26:2442–2450

    Article  CAS  PubMed  Google Scholar 

  28. Margaritis M, Antonopoulos AS, Digby J, Lee R, Reilly S, Coutinho P, Shirodaria C, Sayeed R, Petrou M, de Silva R, Jalilzadeh S, Demosthenous M, Bakogiannis C, Tousoulis D, Stefanadis C, Choudhury RP, Casadei B, Channon KM, Antoniades C (2013) Interactions between vascular wall and perivascular adipose tissue reveal novel roles for adiponectin in the regulation of endothelial nitric oxide synthase function in human vessels. Circulation 127:2209–2221

    Article  CAS  PubMed  Google Scholar 

  29. Neeland IJ, Winders BR, Ayers CR, Das SR, Chang AY, Berry JD, Khera A, McGuire DK, Vega GL, de Lemos JA, Turer AT (2013) Higher natriuretic peptide levels associate with a favorable adipose tissue distribution profile. J Am Coll Cardiol 62:752–760

    Article  CAS  PubMed  Google Scholar 

  30. Lommi J, Kupari M, Yki-Jarvinen H (1998) Free fatty acid kinetics and oxidation in congestive heart failure. Am J Cardiol 81:45–50

    Article  CAS  PubMed  Google Scholar 

  31. Sharma S, Adrogue JV, Golfman L et al (2004) Intramyocardial lipid accumulation in the failing human heart resembles the lipotoxic rat heart. FASEB J 18:1692–1700

    Article  CAS  PubMed  Google Scholar 

  32. Anker SD, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, Harrington D, Kox WJ, Poole-Wilson PA, Coats AJS (1997) Wasting as independent risk factor for mortality in chronic heart failure. Lancet 349:1050–1053

    Article  CAS  PubMed  Google Scholar 

  33. van Bilsen Μ, Smeets PJ, Gilde AJ, van der Vusse GJ (2004) Metabolic remodelling of the failing heart: the cardiac burn-out syndrome? Cardiovasc Res 61:218–226

    Article  CAS  PubMed  Google Scholar 

  34. Arner P (1995) Differences in lipolysis between human subcutaneous and omental adipose tissues. Ann Med 27:435–438

    Article  CAS  PubMed  Google Scholar 

  35. Pivovarova O, Gogebakan O, Kloting N et al (2012) Insulin up-regulates natriuretic peptide clearance receptor expression in the subcutaneous fat depot in obese subjects: a missing link between CVD risk and obesity? J Clin Endocrinol Metab 97:E731–E739

    Article  CAS  PubMed  Google Scholar 

  36. Polak J, Kotrc M, Wedellova Z, Jabor A, Malek I, Kautzner J, Kazdova L, Melenovsky V (2011) Lipolytic effects of B-type natriuretic peptide1–32 in adipose tissue of heart failure patients compared with healthy controls. J Am Coll Cardiol 58:1119–1125

    Article  CAS  PubMed  Google Scholar 

  37. Trevisan R, Fioretto P, Semplicini A, Opocher G, Mantero F, Rocco S, Remuzzi G, Morocutti A, Zanette G, Donadon V, Perico N, Giorato C, Nosadini R (1990) Role of insulin and atrial natriuretic peptide in sodium retention in insulin-treated IDDM patients during isotonic volume expansion. Diabetes 39:289–298

    Article  CAS  PubMed  Google Scholar 

  38. Abouchacra S, Baines AD, Zinman B, Skorecki KL, Logan AG (1994) Insulin blunts the natriuretic action of atrial natriuretic peptide in hypertension. Hypertension 23:1054–1058

    Article  CAS  PubMed  Google Scholar 

  39. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Woo MA, Tillisch JH (2001) The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 38:789–795

    Article  CAS  PubMed  Google Scholar 

  40. Horwich TB, Hamilton MA, Fonarow GC (2006) B-type natriuretic peptide levels in obese patients with advanced heart failure. J Am Coll Cardiol 47:85–90

    Article  CAS  PubMed  Google Scholar 

  41. Costello-Boerrigter LC, Lapp H, Boerrigter G, Lerman A, Bufe A, Macheret F, Heublein DM, Larue C, Burnett JC Jr (2013) Secretion of prohormone of B-type natriuretic peptide, proBNP1-108, is increased in heart failure. JACC Heart Fail 1:207–212

    Article  PubMed  PubMed Central  Google Scholar 

  42. Jordan J, Stinkens R, Jax T, Engeli S, Blaak EE, May M, Havekes B, Schindler C, Albrecht D, Pal P, Heise T, Goossens GH, Langenickel TH (2017) Improved insulin sensitivity with angiotensin receptor neprilysin inhibition in individuals with obesity and hypertension. Clin Pharmacol Ther 101:254–263

    Article  CAS  PubMed  Google Scholar 

  43. Krauser DG, Lloyd-Jones DM, Chae CU, Cameron R, Anwaruddin S, Baggish AL, Chen A, Tung R, Januzzi JL Jr (2005) Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: a ProBNP investigation of dyspnea in the emergency department (PRIDE) substudy. Am Heart J 149:744–750

    Article  CAS  PubMed  Google Scholar 

  44. Taylor JA, Christenson RH, Rao K, Jorge M, Gottlieb SS (2006) B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures. Am Heart J 152:1071–1076

    Article  CAS  PubMed  Google Scholar 

  45. Magnusson M, Jujic A, Hedblad B, Engström G, Persson M, Struck J, Morgenthaler NG, Nilsson P, Newton-Cheh C, Wang TJ, Melander O (2012) Low plasma level of atrial natriuretic peptide predicts development of diabetes: the prospective Malmo Diet and Cancer study. J Clin Endocrinol Metab 97:638–645

    Article  CAS  PubMed  Google Scholar 

  46. Wirth J, Buijsse B, di Giuseppe R, Fritsche A, Hense HW, Westphal S, Isermann B, Boeing H, Weikert C (2014) Relationship between N-terminal pro-brain natriuretic peptide, obesity and the risk of heart failure in middle-aged German adults. PLoS One 9:e113710

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Wilson PW, Vasan RS (2004) Impact of obesity on plasma natriuretic peptide levels. Circulation 109:594–600

    Article  CAS  PubMed  Google Scholar 

  48. McCord J, Mundy BJ, Hudson MP et al (2012) Insulin up-regulates natriuretic peptide clearance receptor expression in the subcutaneous fat depot in obese subjects: a missing link between CVD risk and obesity? J Clin Endocrinol Metab 97:E731–E739

    Article  CAS  Google Scholar 

  49. Rubattu S, Sciarretta S, Ciavarella GM, Venturelli V, de Paolis P, Tocci G, de Biase L, Ferrucci A, Volpe M (2007) Reduced levels of N-terminal-proatrial natriuretic peptide in hypertensive patients with metabolic syndrome and their relationship with left ventricular mass. J Hypertens 25:833–839

    Article  CAS  PubMed  Google Scholar 

  50. Asferg CL, Nielsen J Sr, Andersen UB et al (2013) Metabolic rather than body composition measurements are associated with lower serum natriuretic peptide concentrations in normal weight and obese men. Am J Hypertens 27:620–627

    Article  CAS  PubMed  Google Scholar 

  51. Winter WE, Elin RJ (2004) The role and assessment of ventricular peptides in heart failure. Clin Lab Med 24:235–274

    Article  PubMed  Google Scholar 

  52. Koller KJ, Goeddel DV (1992) Molecular biology of the natriuretic peptides and their receptors. Circulation 86:1081–1088

    Article  CAS  PubMed  Google Scholar 

  53. Ma KK, Ogawa T, de Bold AJ (2004) Selective upregulation of cardiac brain natriuretic peptide at the transcriptional and translational levels by pro-inflammatory cytokines and by conditioned medium derived from mixed lymphocyte reactions via p38 MAP kinase. J Mol Cell Cardiol 36:505–513

    Article  CAS  PubMed  Google Scholar 

  54. Griffin KA, Kramer H, Bidani AK (2008) Adverse renal consequences of obesity. Am J Physiol Renal Physiol 294:F685–F696

    Article  CAS  PubMed  Google Scholar 

  55. Das SR, Drazner MH, Dries DL, Vega GL, Stanek HG, Abdullah SM, Canham RM, Chung AK, Leonard D, Wians FH Jr, de Lemos JA (2005) Impact of body mass and body composition on circulating levels of natriuretic peptides: results from the Dallas Heart Study. Circulation 112:2163–2168

    Article  CAS  PubMed  Google Scholar 

  56. Costello-Boerrigter LC, Burnett JC Jr (2009) A new role for the natriuretic peptides: metabolic regulators of the adipocyte. J Am Coll Cardiol 53:2078–2079

    Article  PubMed  PubMed Central  Google Scholar 

  57. Mizuno Y, Harada E, Katoh D, Kashiwagi Y, Morikawa Y, Nakagawa H, Yoshimura M, Saito Y, Yasue H (2013) Cardiac production of B-type natriuretic peptide is inversely related to the plasma level of free fatty acids in obese individuals — possible involvement of the insulin resistance. Endocr J 60:87–95

    Article  CAS  PubMed  Google Scholar 

  58. Engeli S, Sharma AM (2001) The renin-angiotensin system and natriuretic peptides in obesity-associated hypertension. J Mol Med 79:21–29

    Article  CAS  PubMed  Google Scholar 

  59. von Haehling S, Lainscak M, Springer J, Anker SD (2009) Cardiac cachexia: a systematic overview. Pharmacol Ther 121:227–252

    Article  CAS  Google Scholar 

  60. Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S (1998) The metabolically obese, normal-weight individual revisited. Diabetes 47:699–713

    Article  CAS  PubMed  Google Scholar 

  61. Primeau V, Coderre L, Karelis AD, Brochu M, Lavoie ME, Messier V, Sladek R, Rabasa-Lhoret R (2011) Characterizing the profile of obese patients who are metabolically healthy. Int J Obes 35:971–981

    Article  CAS  Google Scholar 

  62. Karelis A, St-Pierre D, Conus F et al (2004) Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab 89:2569–2575

    Article  CAS  PubMed  Google Scholar 

  63. Bremer A, Devaraj S, Afify A, Jialal I (2011) Adipose tissue dysregulation in patients with metabolic syndrome. J Clin Endocrinol Metab 96:E1782–E1788

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Le K, Mahurakar S, Alderete T et al (2011) Subcutaneous adipose tissue macrophage infiltration is associated with hepatic and visceral fat deposition, hyperinsulinemia, and stimulation of NF-κB stress pathway. Diabetes 60:2802–2809

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Neinast MD, Frank AP, Zechner JF, Li Q, Vishvanath L, Palmer BF, Aguirre V, Gupta RK, Clegg DJ (2015) Activation of natriuretic peptides and the sympathetic nervous system following Roux-en-Y gastric bypass is associated with gonadal adipose tissues browning. Mol Metab 4:427–436

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Cannon B, Nedergaard J (2004) Brown adipose tissue: function and physiological significance. Physiol Rev 84:277–359

    Article  CAS  PubMed  Google Scholar 

  67. Thoonen R, Ernande L, Cheng J, Nagasaka Y, Yao V, Miranda-Bezerra A, Chen C, Chao W, Panagia M, Sosnovik DE, Puppala D, Armoundas AA, Hindle A, Bloch KD, Buys ES, Scherrer-Crosbie M (2015) Functional brown adipose tissue limits cardiomyocyte injury and adverse remodeling in catecholamine-induced cardiomyopathy. J Mol Cell Cardiol 84:202–211

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Bahler L, Verberne HJ, Admiraal WM, Stok WJ, Soeters MR, Hoekstra JB, Holleman F (2016) Differences in sympathetic nervous stimulation of brown adipose tissue between the young and old, and the lean and obese. J Nucl Med 57:372–377

    Article  CAS  PubMed  Google Scholar 

  69. Panagia M, Chen YC, Chen HH et al (2016) Functional and anatomical characterization of brown adipose tissue in heart failure with blood oxygen level dependent magnetic resonance. NMR Biomed 29:978–984

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, Vasan RS, Murabito JM, Meigs JB, Cupples LA, D'Agostino RB, O'Donnell CJ (2007) Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 116:39–48

    Article  PubMed  Google Scholar 

  71. Cheng S, Fox CS, Larson MG, Massaro JM, McCabe EL, Khan AM, Levy D, Hoffmann U, O'Donnell CJ, Miller KK, Newton-Cheh C, Coviello AD, Bhasin S, Vasan RS, Wang TJ (2011) Relation of Visceral adiposity to circulating natriuretic peptides in ambulatory individuals. Am J Cardiol 108:979–984

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Vega GL, Adams-Huet B, Peshock R, Willett D, Shah B, Grundy SM (2006) Influence of body fat content and distribution on variation in metabolic risk. J Clin Endocrinol Metab 91:4459–4466

    Article  CAS  PubMed  Google Scholar 

  73. Boorsma W, Snijder MB, Nijpels G, Guidone C, Favuzzi AMR, Mingrone G, Kostense PJ, Heine RJ, Dekker JM (2008) Body composition, insulin sensitivity, and cardiovascular disease profile in healthy Europeans. Obesity (Silver Spring) 16:2696–2701

    Article  CAS  Google Scholar 

  74. Okura T, Nakata Y, Yamabuki K, Tanaka K (2004) Regional body composition changes exhibit opposing effects on coronary heart disease risk factors. Arterioscler Thromb Vasc Biol 24:923–929

    Article  CAS  PubMed  Google Scholar 

  75. Khawaja T, Greer C, Chokshi A, Chavarria N, Thadani S, Jones M, Schaefle K, Bhatia K, Collado JE, Shimbo D, Einstein AJ, Schulze PC (2011) Epicardial fat volume in patients with left ventricular systolic dysfunction. Am J Cardiol 108:397–401

    Article  PubMed  Google Scholar 

  76. Tabakci MM, Durmuş Hİ, Avci A, Toprak C, Demir S, Arslantaş U, Cerşit S, Fidan S, Kulahçioğlu Ş, Batgerel U, Kargin R (2015) Relation of epicardial fat thickness to the severity of heart failure in patients with nonischemic dilated cardiomyopathy. Echocardiography 32:740–748

    Article  PubMed  Google Scholar 

  77. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey de Jr, Colvin MM, Drazner MH, Filippatos G, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride P, Peterson PN, Stevenson LW, Westlake C (2016) 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 68:1476–1488

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. 1st Cardiology Department, Hippokration General Hospital, Athens Medical School, Athens, Greece

    Vasiliki Katsi, Alexios S. Antonopoulos, Dimitrios Vrachatis & Dimitris Tousoulis

  2. Cardiology Department, Heraklion University Hospital, University of Crete, School of Medicine, Heraklion, Greece

    Maria Marketou & Fragkiskos Parthenakis

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  1. Vasiliki Katsi
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  2. Maria Marketou
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Katsi, V., Marketou, M., Antonopoulos, A.S. et al. B-type natriuretic peptide levels and benign adiposity in obese heart failure patients. Heart Fail Rev 24, 219–226 (2019). https://doi.org/10.1007/s10741-018-9739-3

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