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Prognostic value of neurohormonal activation and cardiopulmonary exercise testing in patients with chronic heart
R Isnard1, F Pousset, J Trochu
1service de Cardiologie, Institut Fédératif de Recherche 14 "Heart, vessels, muscle" Hôpital Pitié-Salpêtrière, Paris, France. richard.isnard@psl.ap-hop-paris.fr
Insights
Plasma neurohormones like atrial natriuretic peptide (ANP) and norepinephrine offer superior long-term prognostic value in moderate congestive heart failure (CHF) compared to exercise testing alone. These biomarkers help identify high-risk patients more effectively.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Congestive heart failure (CHF) management requires accurate long-term prognostic tools.
- Cardiopulmonary exercise testing (CPET) is a common prognostic indicator.
- The role of plasma neurohormones in predicting CHF outcomes needs further elucidation.
Purpose of the Study:
- To compare the prognostic value of plasma neurohormones and CPET in patients with moderate CHF.
- To identify independent predictors of long-term adverse events in CHF patients.
Main Methods:
- 264 patients with CHF and left ventricular systolic dysfunction were studied.
- Plasma levels of atrial natriuretic peptide (ANP), norepinephrine, and endothelin-1 were measured at rest.
- Patients underwent symptom-limited maximal exercise testing to determine peak oxygen consumption (VO(2)).
Main Results:
- Plasma ANP, left ventricular ejection fraction, and plasma norepinephrine were independent predictors of death or urgent heart transplantation in multivariate analysis.
- Peak VO(2) and its percentage of predicted value were not independent predictors.
- Plasma ANP and norepinephrine provided additional prognostic information beyond exercise testing.
Conclusions:
- Plasma ANP and norepinephrine measurements are valuable complementary or alternative tools for prognostic determination in moderate CHF.
- Routine measurement of these neurohormones can aid in identifying high-risk CHF patients.
- This approach enhances risk stratification beyond traditional exercise testing.
Abstract:
We compared the value of plasma neurohormones and cardiopulmonary exercise testing for predicting long-term prognosis in patients with moderate congestive heart failure (CHF). We studied 264 consecutive patients with CHF due to left ventricular systolic dysfunction. Plasma atrial natriuretic peptide (ANP), norepinephrine, and endothelin-1 were measured at rest in all patients, who also underwent a symptom-limited maximal exercise with oxygen consumption (VO(2)) determination. After a median follow-up of 789 days, 52 deaths and 31 heart transplantations occurred, of which 4 were urgent. In an univariate analysis, New York Heart Association functional class, systolic blood pressure at rest, left ventricular end-diastolic diameter, left ventricular ejection fraction, peak VO(2), percent of predicted peak VO(2), plasma ANP, plasma norepinephrine, and plasma endothelin-1 were associated with survival without urgent heart transplantation. In a multivariate stepwise regression analysis, only plasma ANP (p = 0.0001), left ventricular ejection fraction (p = 0.007), and plasma norepinephrine (p = 0.035), but neither peak VO(2) nor percentage of predicted peak VO(2), were independent predictors of death or urgent heart transplantation. Determination of plasma ANP and norepinephrine provides additional independent information for long-term prognostic determination compared with exercise testing alone. Measurement of plasma neurohormones should therefore be considered routinely as a complementary or alternative tool for identifying high-risk patients with moderate CHF.