The predictability of renin–angiotensin–aldosterone system factors for clinical outcome in patients with acute decompensated heart failure

Yasuki Nakada, Hiroyuki Takahama, Hideaki Kanzaki, Yasuo Sugano, Takuya Hasegawa, Takahiro Ohara, Makoto Amaki, Akira Funada, Akemi Yoshida, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

研究成果: Article査読

15 被引用数 (Scopus)

抄録

Although counter-regulation between B-type natriuretic peptide (BNP) levels and renin–angiotensin–aldosterone system (RAAS) activation in heart failure (HF) has been suggested, whether the regulation is preserved in acute decompensated heart failure (ADHF) patients remains unclear. This study aimed to determine: (1) the relationship between RAAS activation and clinical outcomes in ADHF patients, and (2) the relationships between plasma BNP levels and degrees of activation in RAAS factors. This study included ADHF patients (n = 103, NYHA3-4, plasma BNP > 200 pg/ml). We studied the predictability of RAAS factors for cardiovascular events and the relationships between plasma BNP levels and the degrees of activation in RAAS factors, which were evaluated by plasma renin activity (PRA) and aldosterone concentration (PAC). PRA was a strong predictor of cardiovascular (CV) events over 1 year, even after accounting for plasma BNP levels (hazard ratio (HR): 1.04, CI [1.02–1.06], p < 0.01) and medication such as RAAS blockers (HR: 1.03, CI [1.01–1.05], p < 0.01), whereas PAC was borderline-significant (univariate analysis, p = 0.06). Cut-off value of PRA (5.3 ng/ml/h) was determined by AUC curve. Of the enrolled patients, higher PRA was found in 40 % of them. Although no correlation between the plasma BNP levels and PRA was found (p = 0.36), after adjusting for hemodynamic parameters, eGFR and medication, a correlation was found between them (p = 0.01). Elevated RAAS factors were found in a substantial number of ADHF patients with high plasma BNP levels in the association with hemodynamic state, which predicts poor clinical outcomes. The measurements of RAAS factors help to stratify ADHF patients at risk for further CV events.

本文言語English
ページ(範囲)925-931
ページ数7
ジャーナルHeart and Vessels
31
6
DOI
出版ステータスPublished - 2016 6 1
外部発表はい

ASJC Scopus subject areas

  • 循環器および心血管医学

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