title: Relation between major indices of prognosis in patients with chronic congestive heart failure: studies of maximal exercise oxygen consumption, neurohormones and ventricular function.
abstract: Peak exercise capacity (Peak VO2), neurohormonal changes, ventricular enlargement and ejection fraction are among the most important determinants of prognosis in congestive heart failure. However, the inter-relation between these parameters is unknown. We, therefore, correlated these indices in patients with hemodynamically severe congestive heart failure (NYHA class II, pulmonary artery wedge pressure 25 +/- 2 mm Hg, cardiac index 2.5 +/- 0.2 l/min/m2, ejection fraction 43 +/- 2% and fractional shortening 19 +/- 1%). Peak VO2 measured directly during exercise by breath to breath expiratory gas analysis using a metabolic cart was 23 ml/min/kg. Plasma epinephrine (E) and norepinephrine (NE) were measured by high performance liquid chromatography (HPLC) and plasma renin activity (PRA), aldosterone (Aldo), cortisol, prolactin, growth hormone, anti-diuretic hormone (ADH) and antinatriuretic peptide (ANP) by radioimmunoassay. Ejection fraction was measured by echocardiography. There was no relation between peak VO2 and any of the neurohormones E: r = -0.43, NE: r = -0.43, ANP: r = -0.49, Cortisol: r = -0.37, ADH: r = -0.07, Aldo: r = -0.45, 2 tail critical value 0.55. PRA showed a modest correlation (r = -0.61). Similarly, there was no relation between ejection fraction or degree of ventricular enlargement and any of the other indices (r = -0.05). We conclude that although peak VO2, neurohormonal profile and ventricular function are important individual prognostic determinants, there seems to be no direct relation between them.
authors.affiliation: Department of Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh.
authors.forename: Y
authors.initials: Y
authors.lastname: Chandrashekhar
authors.forename: I S
authors.initials: IS
authors.lastname: Anand
mesh_terms: D000328:Adult; D002395:Catecholamines / Q000097:blood; D017079:Exercise Tolerance; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006439:Hemodynamics; D006728:Hormones / Q000097:blood; D006801:Humans; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis
chemical_list: D002395:Catecholamines; D006728:Hormones