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Prognostic evaluation of neurohumoral plasma levels before and during beta-blocker therapy in advanced left
1Department of Cardiology, Ludwig Boltzmann Institute of Experimental Endocrinology, University of Vienna, Austria. edith tanzl@akh-wien.ac.at
Insights
B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) plasma levels predict mortality in advanced heart failure patients on blocking therapy. These biomarkers are crucial for monitoring heart failure progression.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Heart failure involves progressive left ventricular (LV) deterioration.
- Associated with elevated cardiac and extracardiac hormone levels, including natriuretic peptides and norepinephrine.
- Neurohumoral factors play a critical role in the pathophysiology of heart failure.
Purpose of the Study:
- To evaluate the predictive value of neurohumoral factors in patients with advanced LV dysfunction.
- To assess the potency of these factors during neurohumoral blocking therapy.
- To determine the relationship between specific hormone levels and mortality.
Main Methods:
- 91 patients with LVEF <25% received enalapril and atenolol or placebo.
- Plasma hormone levels (BNP, NT-proBNP, norepinephrine, big ET) were measured serially.
- Multivariate regression analyses identified independent predictors of mortality.
Main Results:
- Log BNP plasma levels, treatment allocation, and LVEF independently predicted mortality at baseline.
- During follow-up, log BNP remained the strongest predictor.
- LVEF, log NT-proBNP, and treatment allocation provided additional independent prognostic information.
Conclusions:
- BNP and NT-proBNP plasma levels are independently associated with mortality in advanced LV dysfunction patients on ACE inhibitor and beta-blocker therapy.
- These natriuretic peptides are vital indicators for detecting heart failure progression.
- Biomarkers like BNP and NT-proBNP are valuable for monitoring heart failure, even with concurrent neurohumoral blockade.
Objectives:
The study assessed the relative predictive potency of neurohumoral factors in patients with advanced left ventricular (LV) dysfunction during neurohumoral blocking therapy.
Background:
The course of heart failure is characterized by progressive LV deterioration associated with an increase in cardiac (natriuretic peptides) and predominantly extracardiac (norepinephrine, big endothelin [big ET]) hormone plasma levels.
Methods:
Plasma hormones were measured at baseline and months 3, 6, 12 and 24 in 91 patients with heart failure (left ventricular ejection fraction [LVEF] <25%) receiving 40 mg enalapril/day and double-blind atenolol (50 to 100 mg/day) or placebo. After the double-blind study phase, patients were followed up to four years. Stepwise multivariate regression analyses were performed with 10 variables (age, etiology, LVEF, symptom class, atenolol/placebo, norepinephrine, big ET, log aminoterminal atrial natriuretic peptide, log aminoterminal B-type natriuretic peptide [N-BNP] and log B-type natriuretic peptide [BNP]). During the study, the last values prior to patient death were used, and in survivors the last hormone level, New York Heart Association class and LVEF at month 24 were used.
Results:
Thirty-one patients died from a cardiovascular cause during follow-up. At baseline, log BNP plasma level (x2 = 13.9, p = 0.0002), treatment allocation (x2 = 9.5, p = 0.002) and LVEF (x2 = 5.6, p = 0.017) were independently related to mortality. During the study, log BNP plasma level (x2 = 21.3, p = 0.0001) remained the strongest predictive marker, with LVEF (x2 = 11.2, p = 0.0008) log N-BNP plasma level (x2 = 8.9, p = 0.0027) and treatment allocation (x2 = 6.4, p = 0.0109) providing additional independent information.
Conclusions:
In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they will likely emerge as a very useful blood test for detection of the progression of heart failure, even in the face of neurohumoral blocking therapy.