Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications

1 Consiglio Nazionale delle Ricerca Institute of Clinical Physiology and 2 Scuola Superiore Sant’Anna, Pisa, Italy; and 3 New York Medical College, Valhalla, New York The discovery of cardiac natriuretic hormones required a profound revision of the concept of heart function. The heart should no longer be considered only as a pump but rather as a multifunctional and interactive organ that is part of a complex network and active component of the integrated systems of the body. In this review, we first consider the cross-talk between endocrine and contractile function of the heart. Then, based on the existing literature, we propose the hypothesis that cardiac endocrine function is an essential component of the integrated systems of the body and thus plays a pivotal role in fluid, electrolyte, and hemodynamic homeostasis. We highlight those studies indicating how alterations in cardiac endocrine function can better explain the pathophysiology of cardiovascular diseases and, in particular of heart failure, in which several target organs develop a resistance to the biological action of cardiac natriuretic peptides. Finally, we emphasize the concept that a complete knowledge of the cardiac endocrine function and of its relation with other neurohormonal regulatory systems of the body is crucial to correctly interpret changes in circulating natriuretic hormones, especially the brain natriuretic peptide. atrial natriuretic peptide; brain natriuretic peptide; cardiac natriuretic hormones; cardiac function; heart failure; cardiovascular diseases Address for reprint requests and other correspondence: A. Clerico, Laboratory of Cardiovascular Endocrinology and Cell Biology, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy (email: clerico{at}ifc.cnr.it )