23404
document
Usefulness of temporal changes in neurohormones as markers of ventricular remodeling and prognosis in patients with left ventricular systolic dysfunction and heart failure receiving either candesartan or enalapril or both . Although various neurohormones at initial measurement confer prognostic value in heart failure and correlate with the left ventricular ejection fraction ( EF ) and cardiac volumes , the significance of their temporal changes ( Delta ) remains undetermined . This study examined temporal changes in neurohormones related to cardiac remodeling and prognosis in patients with systolic dysfunction and heart failure receiving therapeutic inhibition of the renin-angiotensin-aldosterone system . Temporal changes in plasma renin , angiotensin-II , aldosterone , epinephrine , norepinephrine , B-type natriuretic peptide ( BNP ) , and N-terminal atrial natriuretic peptide ( NT-ANP ) in 768 treated patients with heart failure measured at baseline and 17 and 43 weeks after randomization were examined for their relations with concurrent changes in the EF , cardiac volumes , and risk for subsequent adverse clinical outcomes . Increasing BNP ( p < 0.0001 ) and NT-ANP ( p = 0.01 ) over time were associated with a concurrent decreasing EF , increasing end-diastolic volume ( EDV ) , and increasing end-systolic volume ( ESV ; all p < 0.0001 ) . In multivariable analysis , DeltaBNP and DeltaNT-ANP were independent predictors of DeltaESV and DeltaEDV , whereas DeltaBNP also predicted DeltaEF ( all p < 0.0001 ) . Patients who died or experienced heart failure hospitalization had larger antecedent increases in NT-ANP ( +293.7 vs -21.5 pmol/ml , p = 0.006 ) and lesser decreases in norepinephrine ( -22.3 vs -48.5 pg/ml , p = 0.04 ) . Increasing NT-ANP ( hazard ratio [ HR ] 3.45 , p = 0.009 ) and norepinephrine ( HR 2.04 , p = 0.02 ) over time independently predicted increased risk for subsequent death or heart failure hospitalization . In conclusion , in treated patients with heart failure , increasing NT-ANP and BNP over time predict a decreasing EF and ventricular dilatation , while increasing NT-ANP and norepinephrine independently predict greater mortality and morbidity . Serial measurements of these neurohormones may serve as useful surrogate markers of ventricular remodeling and prognosticators for clinical risk stratification .
23405
Intervention_Pharmacological
candesartan
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Intervention_Pharmacological
enalapril
23407
Outcome_Physical
left ventricular ejection fraction ( EF )
23408
Outcome_Physical
cardiac volumes
23409
Outcome_Physical
changes in neurohormones
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Outcome_Physical
Temporal changes in plasma renin
23411
Outcome_Physical
angiotensin-II
23412
Outcome_Physical
aldosterone
23413
Outcome_Physical
epinephrine
23414
Outcome_Physical
norepinephrine
23415
Outcome_Physical
B-type natriuretic peptide ( BNP )
23416
Outcome_Physical
N-terminal atrial natriuretic peptide ( NT-ANP )
23417
Outcome_Physical
EF
23418
Outcome_Physical
cardiac volumes
23419
Outcome_Physical
risk for subsequent adverse clinical outcomes
23420
Outcome_Physical
BNP
23421
Outcome_Physical
NT-ANP
23422
Outcome_Physical
EF
23423
Outcome_Physical
end-diastolic volume ( EDV )
23424
Outcome_Physical
end-systolic volume
23425
Outcome_Mortality
died
23426
Outcome_Physical
experienced heart failure hospitalization
23427
Outcome_Physical
NT-ANP
23428
Outcome_Physical
norepinephrine
23429
Outcome_Physical
NT-ANP
23430
Outcome_Mortality
death
23431
Outcome_Physical
heart failure hospitalization
23432
Outcome_Physical
EF
23433
Outcome_Physical
ventricular dilatation
23434
Outcome_Mortality
mortality
23435
Outcome_Physical
morbidity
23436
Outcome_Physical
ventricular remodeling
23437
Participant_Condition
patients with left ventricular systolic dysfunction and heart failure receiving either candesartan or enalapril or both .