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document
Plasma norepinephrine and mortality . Plasma norepinephrine levels , which reflect sympathetic nervous system activity , are almost universally elevated in patients with left ventricular dysfunction . This elevation occurs in patients with overt , symptomatic heart failure ( HF ) and in patients with asymptomatic left ventricular dysfunction . Evidence suggests that the elevation in plasma norepinephrine levels can be at least partly attributed to an increase in sympathetic nervous system activity . It has become evident that elevated plasma norepinephrine levels are directly related to prognosis ; patients with levels > 900 pg/ml have a poor prognosis and shortened life expectancy . However , plasma norepinephrine levels bear little relationship to physiologic and clinical variables observed in HF , including ejection fraction and exercise capacity . Data from the V-HeFT II show that at 2-year follow-up , a progressive rise of plasma norepinephrine was observed in both treatment arms , suggesting that disease progresses despite treatment with either an angiotensin-converting enzyme inhibitor , enalapril , or vasodilator therapy with hydralazine/isosorbide dinitrate . It is possible that interventions aimed at the progressive neurohormonal activation that occurs in HF may improve the course of illness . Further study is needed to test this hypothesis .
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Intervention_Pharmacological
enalapril
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Intervention_Pharmacological
hydralazine/isosorbide dinitrate
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Outcome_Physical
plasma norepinephrine levels
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Outcome_Physical
ejection fraction
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Outcome_Physical
exercise capacity
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Outcome_Physical
rise of plasma norepinephrine
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Participant_Condition
patients with left ventricular dysfunction .