Sympathetic and renin-angiotensin-aldosterone system activation in heart failure with preserved, mid-range and reduced ejection fraction
| Autor: | Luc Zyw, Michele Emdin, Alberto Giannoni, Concetta Prontera, Valentina Spini, Nicolò Ghionzoli, Chiara Arzilli, Alessandra Gabutti, Alberto Aimo, Giuseppe Vergaro, Claudia Taddei, Roberta Poletti, Claudio Passino, Chiara Mammini |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Ejection fraction medicine.medical_specialty Biomarkers Heart failure Neurohormones Sympathetic Nervous System medicine.drug_class Population 030204 cardiovascular system & hematology Plasma renin activity Renin-Angiotensin System 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Renin–angiotensin system medicine Natriuretic peptide Humans 030212 general & internal medicine education Aged Retrospective Studies Heart Failure education.field_of_study Aldosterone business.industry Stroke Volume medicine.disease Epinephrine chemistry Cardiology Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | International Journal of Cardiology. 296:91-97 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2019.08.040 |
| Popis: | Evidence of sympathetic and renin-angiotensin-aldosterone system activation provided a rationale for neurohormonal antagonism in heart failure with reduced ejection fraction (HFrEF), while no data are available in patients with milder degree of systolic dysfunction. We aimed to investigate neurohormonal function in HF with preserved and mid-range EF (HFpEF/HFmrEF).Three cohorts (n = 189/each) of stable HFpEF, HFmrEF and HFrEF patients were selected (median age 70, 67 and 67 years; male 56%, 73% and 74%, respectively). Patients received a baseline clinical assessment including plasma renin activity (PRA), aldosterone, catecholamines, and N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) assays, and were followed-up for all-cause death.Neuroendocrine profile was similar between HFpEF and HFmrEF, while all neurohormones except epinephrine were higher in HFrEF than in HFmrEF (NT-proBNP 2332 ng/L, IQR 995-5666 vs 575 ng/L, 205-1714; PRA 1.7 ng/mL/h, 0.4-5.6 vs 0.6 ng/mL/h, 0.2-2.6; aldosterone 153 ng/L, 85-246 vs 113 ng/L, 72-177; norepinephrine 517 ng/L, 343-844 vs 430 ng/L, 259-624; all p 0.001, epinephrine 31 ng/L, 10-63 vs 25 ng/L, 10-44; p = 0.319). These findings were unrelated to treatment heterogeneity. Ten percent of HFpEF patients had elevated PRA, aldosterone and norepinephrine vs. 8% in HFmrEF and 21% in HFrEF. During a 5-year follow-up, survival decreased with the number of neurohormones elevated (HFpEF: log-rank 7.8, p = 0.048; HFmrEF: log-rank 11.8, p = 0.008; HFrEF: log-rank 8.1, p = 0.044).Neurohormonal activation is present only in a subset of patients with HFpEF and HFmrEF, and may hold clinical significance. Neurohormonal antagonism may be useful in selected HFpEF/HFmrEF population. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect