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Cardiac and renal dysfunction in chronic heart failure: relation to neurohumoral activation and prognosis
1IRCCS, Institute of Cardiology, University of Milan, Italy. giancarlo.marenzi@cardiologicomonzino.it
Insights
In chronic heart failure, both cardiac and renal dysfunction significantly contribute to neurohumoral activation. This activation is closely linked to reduced long-term survival in patients with heart failure.
Area of Science:
- Cardiology
- Nephrology
- Neuroendocrinology
Background:
- Cardiac dysfunction is a known driver of neurohumoral activation in chronic heart failure (CHF).
- The specific contribution of renal impairment to neurohumoral activation in CHF remains less defined.
- This study aimed to clarify the interplay between cardiac and renal function and neurohumoral status in CHF patients.
Purpose of the Study:
- To investigate the relationship between cardiac dysfunction, renal impairment, and neurohumoral activation in CHF patients.
- To assess the impact of these factors on long-term prognosis and survival.
Main Methods:
- Evaluated hemodynamics, renal function (serum creatinine), and plasma neurohormones in 148 CHF patients.
- Patients were categorized into four groups based on systolic volume index (cardiac function) and serum creatinine levels (renal function).
- Long-term follow-up data was collected to assess survival rates.
Main Results:
- Neurohormone levels progressively increased across the four patient groups, correlating with both cardiac and renal dysfunction.
- Patients with renal dysfunction exhibited markedly increased neurohormones compared to those with normal renal function.
- Long-term survival progressively decreased from Group I to IV, with significantly poorer outcomes in patients presenting with renal dysfunction.
Conclusions:
- Neurohumoral activation in CHF is strongly associated with long-term survival.
- Both cardiac and renal dysfunction play significant roles in the development and progression of neurohumoral activation.
- Renal dysfunction is a critical factor influencing prognosis in CHF patients.
Background:
In chronic heart failure (CHF), cardiac dysfunction is considered the major determinant of neurohumoral activation but the role of renal impairment has not been defined. We investigated the relationship between both cardiac and renal dysfunction and neurohumoral activation, and their possible influence on prognosis.
Methods:
Hemodynamics, renal function, plasma neurohormones, and long-term follow-up were evaluated in 148 CHF patients, grouped according to systolic volume index (SVI) and serum creatinine (CRE) values: SVI > 28 mL/m2 and CRE < 1.5 mg/dL (group I, n = 55), SVI < 28 mL/m2 and CRE < 1.5 mg/dL (group II, n = 37), SVI > 28 mL/m2 and CRE > 1.5 mg/dL (group III, n = 25), SVI < 28 mL/m2 and CRE > 1.5 mg/dL (group IV, n = 31).
Results:
Neurohormones progressively increased from Group I through IV and correlated with both cardiac and renal function. The hemodynamic pattern was similar in patients with normal or abnormal renal function, whereas neurohormones were only moderately increased in the former group and markedly increased in the latter group. Long-term survival progressively decreased from Group I through IV and was significantly poorer in patients with renal dysfunction.
Conclusions:
Our study confirms that, in CHF, neurohumoral activation is strictly related to long-term survival and that many factors contribute to its development and progression; among these, cardiac and renal dysfunction seem to play a major role.
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