Adaptive cardiovascular hormones in a spectrum of heart failure phenotypes. (15th June 2015)

• Record Type: Journal Article
• Authors: Zabarovskaja, Stanislava; Hage, Camilla; Linde, Cecilia; Daubert, Jean-Claude; Donal, Erwan; Gabrielsen, Anders; Mellbin, Linda; Lund, Lars H.
• Is Part Of: International journal of cardiology. Volume 189(2015)
• Page Start: 6
• Page End: 11
• Publication Date: 2015-06-15
• Subjects: ADM adrenomedullin -- ANOVA analysis of variance -- ANP atrial natriuretic peptide -- BNP brain natriuretic peptide -- CI cardiac index -- CO cardiac output -- EDTA ethylenediaminetetraacetic acid -- EF ejection fraction -- GFR glomerular filtration rate -- HF heart failure -- HFpEF heart failure with preserved ejection fraction -- HFrEF heart failure with reduced ejection fraction -- HTx heart transplantation -- LV left ventricle -- LVAD left ventricular assist device -- LVEF left ventricular ejection fraction -- MR-proADM midregional pro-adrenomedullin -- MR-proANP midregional pro-atrial natriuretic peptide -- NT-proBNP N-terminal pro-brain natriuretic peptide -- NYHA New York Heart Failure Association -- RAAS renin angiotensin aldosterone system; NT-proBNP -- MR-proANP -- MR-proADM -- Heart failure with preserved ejection fraction -- Heart transplantation -- Ventricular assist device; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.03.381
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background/objectives: In heart failure (HF), activation of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP) and adrenomedullin (ADM) is adaptive. The activation of these peptides in relation to different HF phenotypes such as HF with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF) and after left ventricular assist device (LVAD) and heart transplantation (HTx) remains poorly characterized. Methods: We measured and compared N-terminal (NT)-proBNP, mid-regional (MR)-proANP and mid-regional (MR)-proADM in 86 patients with HFpEF, 49 patients with HFrEF, 13 patients one year post-LVAD and 22 patients one year post-HTx. We assessed their prognostic impact using Kaplan–Meier analysis and multivariable Cox regression. Results: In HFpEF, HFrEF, LVAD and HTx, NT-proBNP, median (inter-quartile range), was 1000 (465–2335), 3145 (1475–5190), 1430 (986–2570), and 208 (127–353) pmol/L, p < 0.001. MR-proANP was 313 (192–381), 449 (325–596), 276 (216–305), and 118 (96–163) pmol/L, p < 0.001. MR-proADM was 1.2 (0.9–1.6), 1.3 (0.9–2.0), 0.9 (0.7–1.4), and 0.7 (0.6–0.9) nmol/L, p < 0.001 overall and p = 0.212 HFpEF versus HFrEF. In both HFpEF and HFrEF, NT-proBNP and MR-proANP predicted survival free from HTx or LVAD, independent of age, gender, NYHA class and eGFR, whereas MR-proADM did not. Conclusions: Patterns of the cardiomyocyte stress hormones NT-proBNP and MR-proANP suggest that compared to HFrEF, HFpEF may represent milder disease and LVAD and HTx may represent progressive resolution of HF severity. NT-proBNP and MR-proANP independently predicted prognosis in both HFpEF and HFrEF. In contrast, MR-proADM did not distinguish between HFpEF and HFrEF, did not predict prognosis in either, and may be more non-specific in HF.