Chest
Special FeaturesDiagnostic Usefulness of B-Type Natriuretic Peptide and Functional Consequences of Muscle Alterations in COPD and Chronic Heart Failure
Section snippets
BNP and Pro-BNP Synthesis, Release, and Inactivation
The precursor of BNP, pro-BNP, is synthesized in rapid bursts predominantly by ventricular myocytes and to a lesser extent by atrial myocytes.13 Pro-BNP is stored in secretory granules.14 Pro-BNP is cleaved by an endoprotease into BNP, the 32 amino acid active hormone, and a 76 amino acid N-terminal inactive fragment (NT-pro-BNP). The most potent stimulus for pro-BNP synthesis is an increase in ventricular wall tension.15, 16, 17 Lesser stimuli for pro-BNP synthesis are myocyte hypoxia,
Muscle Mass, Metabolism, and Fiber Distribution
As patients with COPD and chronic heart failure become increasingly symptomatic, they exhibit strikingly similar alterations in skeletal muscles.39, 40, 41, 42, 43, 44 Cross-sectional area of thigh muscle is reduced in patients with COPD and in patients with chronic heart failure when compared to age-matched healthy subjects.44, 45 Skeletal muscle biopsies reveal indistinguishable abnormalities in patients with advanced CODP and chronic heart failure.39, 44 Abnormalities include loss of muscle
COPD
Presumably due to increased energy expenditure, the changes in the respiratory muscles of patients with COPD are opposite to those observed in skeletal muscles.76 Although its mass is somewhat reduced, the diaphragm contains relatively more type I fibers than that of healthy subjects. Malnutrition and glucocorticoid therapy affect mostly type IIa and IIb diaphragmatic fibers in patients with advanced COPD.77 Mitochondrial volume density and oxidative capacity relative to adenosine triphosphate
Mechanisms of Skeletal Muscle Alterations in COPD and Chronic Heart Failure
Since skeletal muscle alterations play an important role in limiting functional capacity in patients with COPD or chronic heart failure, reversal of skeletal muscle alterations is an important therapeutic goal when managing both conditions.44, 55, 56, 57, 92, 93 Reversal of skeletal muscle alterations in patients with COPD or chronic heart failure can be best accomplished with a thorough understanding of the mechanisms that mediate these alterations (Fig 2). However, the mechanisms that are
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