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Prognostic value of plasma catecholamines, plasma renin activity, and plasma atrial natriuretic peptide at rest and during exercise in congestive heart failure: comparison with clinical evaluation, ejection fraction, and exercise capacity
- Source :
- Journal of cardiac failure. 1(3)
- Publication Year :
- 1995
-
Abstract
- Survival in congestive heart failure is related to plasma catecholamines and atrial natriuretic peptide at rest, but the prognostic importance of changes during exercise is unknown. The aim of this study was to evaluate the prognostic value of catecholamines and atrial natriuretic peptide at rest and during maximal exercise in congestive heart failure, and to compare it to clinical and exercise test variables and left ventricular ejection fraction. One hundred ninety consecutive patients (136 men and 54 women; median age, 66 years; range, 42-75 years) with clinically stable congestive heart failure were included. Sixteen patients were in New York Heart Association class I, 87 in class II, 83 in class III, and 4 in class IV. Left ventricular ejection fraction was 0.30 (range, 0.06-0.74). Total survival after 1 year was 79%, after 2 years, it was 68%. Prognostic variables at univariate analysis were: plasma noradrenaline at rest (P.0001), plasma adrenaline at rest (P = .049), and atrial natriuretic peptide at rest (P = .016). During exercise, plasma catecholamines and plasma atrial natriuretic peptide increased significantly; the change, however, was not related to survival. Six variables carried significant, independent prognostic information in a multivariate analysis: left ventricular ejection fraction (P = .03), plasma noradrenaline at rest (P = .009), New York Heart Association class III + IV (P = .005), increase in heart rate during exerciseor = 35 min-1 (P.0001), serum creatinine121 mumol/L (P = .004), and serum urea7.6 mmol/L (P = .007). Patients with congestive heart failure have a poor survival despite intensive medical treatment. Plasma catecholamines and plasma atrial natriuretic peptide are elevated at rest and rises further during exercise; the increase, however, is not related to mortality. Plasma noradrenaline at rest contributes with further prognostic information despite knowledge of clinical and exercise variables and was the only neurohormonal variable with independent, significant prognostic information on survival.
- Subjects :
- Adult
Male
medicine.medical_specialty
Prognostic variable
Plasma renin activity
Ventricular Function, Left
Catecholamines
Atrial natriuretic peptide
Internal medicine
Heart rate
Renin
medicine
Humans
Prospective Studies
New York Heart Association Class I
Aged
Heart Failure
Univariate analysis
Ejection fraction
Exercise Tolerance
business.industry
Stroke Volume
Middle Aged
medicine.disease
Prognosis
Survival Analysis
Heart failure
Cardiology
Regression Analysis
Female
Cardiology and Cardiovascular Medicine
business
Atrial Natriuretic Factor
Subjects
Details
- ISSN :
- 10719164
- Volume :
- 1
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of cardiac failure
- Accession number :
- edsair.doi.dedup.....f27893844bcf8a575ef68f0f58ad848e