Cardiac risk stratification in patients with congestive heart failure: a catecholamines-beta-adrenoceptor-cAMP pathway.
OBJECTIVE
To investigate the stratification risk of catecholamines-beta-adrenoceptor (beta-AR)-cAMP pathway for cardiogenic death events in patients with congestive heart failure (CHF).


METHODS
A total of 83 identified CHF patients with a baseline and follow-up plasma levels of norepinephrine (NE) and epinephrine (E), lymphocytes beta-AR density (Bmax), and intralymphocyte cAMP content in peripheral blood were followed up. Major cardiogenic death events were registered.


RESULTS
The period between the initial entry and the last follow-up measurement were 51 +/- 16 months, the total duration of clinical follow-up after the last measurement were 14 +/- 8 months. During follow-up, 39 patients died of cardiogenic (sudden death 17 patients, worsening heart failure 22 patients). Persistence of high NE, E, and cAMP from baseline to follow-up were confirmed as risk predicting factors of cardiovascular events. Persistence NE above 4.0 nmol/L, E above 3.5 nmol/L, and the intralymphocyte cAMP content above 3.5 pmd x mg(-1) x pro(-1) from baseline to follow-up were significant adverse prognostic predictors. The major cardiogenic death events rates per 100 patients-years were 1.33 and 4.82 in patients with NE below and above 4.0 nmol/L (HR: 2.91; 95% CI: 1.08-7.33; P = 0.015); were 1.42 and 4.36 in the patients with E levels below and above 3.5 nmol/L (HR: 2.64; 95% CI: 1.02-6.41; P = 0.019); were 1.81 and 4.67 in the patients with the intralymphocyte cAMP content below and above 3.5 pmd x mg(-1) x pro(-1) (HR: 2.79; 95% CI: 1.04-6.83; P = 0.017), but difference was not significant between the beta-AR density below and above median.


CONCLUSIONS
Persistent increase in circulating catecholamines and intralymphocyte cAMP content may increase the long-term mortality in CHF patients.
Peng
Ying-Xin
YX
Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou. upls01@hotmail.com
Shan
Jiang
J
Zhang
Su-jun
SJ
Rong
Chun-li
CL
Li
Jun-ping
JP
Wang
Na
N
Xue
Hao
H
Zheng
Shi-ling
SL
Wu
Min
M
D000368:Aged; D002395:Catecholamines / Q000097:blood*; D000242:Cyclic AMP / Q000097:blood*; D016757:Death, Sudden, Cardiac; D004837:Epinephrine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008214:Lymphocytes / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011943:Receptors, Adrenergic, beta / Q000097:blood*
D002395:Catecholamines; D011943:Receptors, Adrenergic, beta; D000242:Cyclic AMP; D009638:Norepinephrine; D004837:Epinephrine