Transcardiac increase in norepinephrine and prognosis in patients with chronic heart failure.
BACKGROUND
No previous study has compared the transcardiac gradient of norepinephrine (NE) and the prognosis of patients with chronic heart failure (CHF).


OBJECTIVE
To evaluate the prognostic role of the transcardiac gradient of NE in patients with CHF.


METHODS
We measured haemodynamic parameters and plasma levels of NE, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in the aortic root (AO) and coronary sinus (CS) in 356 consecutive patients with CHF.


RESULTS
During a median follow-up of 3.5 years, 40 patients died. Transcardiac gradients of BNP (273+/-276 vs. 472+/-433 pg/mL, p<0.0001), NT-proBNP (417+/-700 vs. 928+/-1093 pg/mL, p<0.0001) and NE (114+/-160 vs. 473+/-992 pg/mL, p<0.0001) were significantly higher in non-survivors than survivors. After adjustment for clinical variables associated with CHF including haemodynamics and neurohumoral factors, the transcardiac gradient of NE (p<0.0001) and plasma log NT-proBNP (p<0.0001) were independent prognostic predictors. Among 67 patients in whom 123I-metaiodobenzylguanidine (MIBG) could be performed, transcardiac increase in NE was correlated with the washout rate (r=0.398, p=0.0009) and was a superior predictor of mortality than MIBG parameters on stepwise multivariable Cox proportional hazards regression analyses.


CONCLUSIONS
The transcardiac increase in NE is an independent and useful prognostic predictor for evaluating the prognosis of CHF patients.
Tsutamoto
Takayoshi
T
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan. tutamoto@belle.shiga-med.ac.jp
Nishiyama
Keizo
K
Sakai
Hiroshi
H
Tanaka
Toshinari
T
Fujii
Masanori
M
Yamamoto
Takashi
T
Yamaji
Masayuki
M
Horie
Minoru
M
D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013997:Time Factors
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine