Relation between plasma norepinephrine and response to medical therapy in men with congestive heart failure secondary to coronary artery disease or idiopathic dilated cardiomyopathy.
This study examines the relation between the change in clinical status and the change in plasma norepinephrine concentration in patients with congestive heart failure (CHF) receiving standard medical therapy. Hemodynamic measurements in 11 patients with CHF (ejection fraction 19 +/- 4%) were obtained before and immediately after the administration of digoxin and angiotensin-converting enzyme inhibitors. Patients were then followed for 1 year. Clinical status was determined using the Boston Clinical Heart Failure scoring system. Of the 11 patients, 6 demonstrated significant clinical improvement after therapy, based on the Boston score, over a 1-year period. Five patients did not respond to therapy: 4 died and the remaining patient had worsening CHF. There was no difference between responders and nonresponders in either baseline hemodynamics or acute response to the administration of digoxin and an angiotensin-converting enzyme inhibitor. In the patients who improved, plasma norepinephrine decreased from 706 +/- 235 to 545 +/- 223 pg/ml (p = 0.08) after 1 year of medical therapy. In patients whose CHF worsened or who died, plasma norepinephrine increased from 715 +/- 275 at baseline to 1,237 +/- 671 pg/ml at their last measurement (p = 0.06). Although at baseline the plasma norepinephrine levels were similar in both groups of patients, a significant difference between responders and nonresponders was observed at final follow-up (p less than 0.002). Change in plasma norepinephrine correlated with change in CHF score (r = 0.79, p less than 0.004). Thus, in patients with CHF, serial measurements of plasma norepinephrine correlate with changes in clinical status.
Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan 48202.
W
W
Kao
M
M
Gheorghiade
V
V
Hall
S
S
Goldstein
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D003327:Coronary Disease / Q000150:complications*; D004077:Digoxin / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D009638:Norepinephrine / Q000097:blood*; D011379:Prognosis; D013318:Stroke Volume
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D004077:Digoxin; D009638:Norepinephrine