title: [Prognostic value of cytokines and neurohormones in severe heart failure].
abstract: OBJECTIVE
  The screening of candidates for heart transplantation continues to present difficulties. High plasma levels of cytokines and neurohormones have been associated with a poor prognosis in heart failure but their usefulness for identifying candidates for heart transplantation is still not established.
  
  
  METHODS
  In 83 patients (59 11 years old), with systolic left ventricular dysfunction and New York Heart Association functional class III-IV, we assessed levels of aldosterone, atrial natriuretic peptide, plasma renin activity, angiotensin II, norepinephrine, endothelin, interleukin-6 and tumor necrosis factor-alpha.
  
  
  RESULTS
  Over the following year, 13 patients died and 26 received heart transplantation. Mean ejection fraction was 23 6%, end-diastolic and end-systolic diameters were 73 10 and 60 10 mm, respectively. Univariate analysis identified the following variables to be associated with poor prognosis: angiotensin II (p = 0.001), norepinephrine (p = 0.003), plasma renin activity (p = 0.02), systolic blood pressure (p = 0.006), end-diastolic diameter (p = 0.02) and end-systolic diameter (p = 0.04). Multivariate regression analysis identified the following variables to be independent predictors of death or need for heart transplantation: a low cardiac index (p = 0.007), plasma angiotensin II (p = 0.001) and pulmonary capillary wedge pressure (p = 0.04) The sensitivity and specificity of angiotensin II for predicting poor outcome was only moderate according to interpretation of the receiver operating curves.
  
  
  CONCLUSIONS
  Although plasma angiotensin II was the best neurohormone for identifying patients with severe heart failure and the worst prognosis, its sensitivity and specificity for predicting death or the need for heart transplantation was limited. The decision to transplant should continue to be based on clinical and hemodynamic parameters.
authors.affiliation: Institut Clínic de Malalties Cardiovasculars, Hospital Clinic de Barcelona, Spain.
authors.forename: Bàrbara
authors.initials: B
authors.lastname: Vidal
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Roig
authors.forename: Félix
authors.initials: F
authors.lastname: Pérez-Villa
authors.forename: Josefina
authors.initials: J
authors.lastname: Orús
authors.forename: Joaquín
authors.initials: J
authors.lastname: Pérez
authors.forename: Vladimiro
authors.initials: V
authors.lastname: Jiménez
authors.forename: Alberto
authors.initials: A
authors.lastname: Leivas
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cuppoletti
authors.forename: Mercè
authors.initials: M
authors.lastname: Roqué
authors.forename: Ginés
authors.initials: G
authors.lastname: Sanz
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006334:Heart Function Tests; D016027:Heart Transplantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018377:Neurotransmitter Agents