[Prognostic value of elevation of plasma concentration of atrial natriuretic peptide in patients with cardiac failure. Results of a cohort study].
A total of 172 patients with cardiac failure (CF) of functional class II-IV aged 46-62 years were studied. Clinical condition of the patients was stabilized by the conventional therapy including ACE inhibitor--enalapril in a dose 10-20 mg/day. In 3 weeks this therapy was combined with losartan in a dose 25-50 mg/day. The course of treatment was 48 weeks. Cardiodynamics was assessed by duplex echocardiography and dopplerography. Plasmic concentrations of atrial sodiumuretic peptide (ASUP), renin, angiotensin-II, aldosteron, norepinephrine, epinephrine, serotonin, hydrocortisone, endothelin-1 were measured with radioimmunoassay. In the study group there were 31 deaths for 48 weeks. ASUP concentration in the deceased was significantly higher than in the survivors (n = 141). The stepwise regression analysis discovered correlation between plasmic ASUP and end-diastolic volume of the left ventricle (r = 0.62; p = 0.01), dopplerographic index (r = 0.52; p = 0.001), left ventricular ejection fraction (r = -0.66; p = 0.002), velocity of early diastolic filling (r = -0.84; p = 0.001), plasmic pool of norepinephrine (r = 0.66; p = 0.001), endotheline-1 (r = 0.70; p = 0.03) and angiotensin-II (r = 0.55; p = 0.02), daily dose of furosemide (r = 0.80; p = 0.001), heart rate (r = 0.64; p = 0.02). The strongest negative effect on CF patients' survival was linked with plasmic content of ASUP (relative risk = 4.55), angiotensin-II (RR = 3.2), ejection fraction < 25% (RR = 3.02). Thus, elevation of ASUP in blood plasm can be regarded a marker of a high cardiovascular risk of CF patients treated with AT-antagonist.
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D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000097:blood*; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D004656:Enalapril / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011863:Radioimmunoassay; D012044:Regression Analysis; D012306:Risk; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D004656:Enalapril; D009320:Atrial Natriuretic Factor; D019808:Losartan