title: Prognostic value of emerging neurohormones in chronic heart failure during optimization of heart failure-specific therapy.
abstract: BACKGROUND
  Serial measurements of neurohormones have been shown to improve prognostication in the setting of acute heart failure (HF) or chronic HF without therapeutic intervention. We investigated the prognostic role of serial measurements of emerging neurohormones and BNP in a cohort of chronic HF patients undergoing increases in HF-specific therapy.
  
  
  METHODS
  In this prospective study we included 181 patients with chronic systolic HF after an episode of hospitalization for worsening HF. Subsequently, HF therapy was gradually increased in the outpatient setting until optimized. We measured copeptin, midregional proadrenomedullin, C-terminal endothelin-1 precursor fragment, midregional proatrial natriuretic peptide, and B-type natriuretic peptide before and after optimization of HF therapy. The primary endpoint was all-cause mortality at 24 months.
  
  
  RESULTS
  Angiotensin-converting enzyme/angiotensin receptor blocker and beta-blockers were increased significantly during the 3-month titration period (P < 0.0001 for both). In a stepwise Cox regression analysis adjusted for age, sex, glomerular filtration rate, diabetes mellitus, and ischemic HF, baseline and follow-up neurohormone concentrations were predictors of the primary endpoint as follows (baseline hazard ratios): copeptin 1.92, 95% CI 1.233-3.007, P = 0.004; midregional proadrenomedullin 2.79, 95% CI 1.297-5.995, P = 0.009; midregional proatrial natriuretic peptide 2.05, 95% CI 1.136-3.686, P = 0.017; C-terminal endothelin-1 precursor fragment 2.24, 95% CI 1.133-4.425, P = 0.025; B-type natriuretic peptide 1.46, 95% CI 1.039-2.050, P = 0.029.
  
  
  CONCLUSIONS
  In pharmacologically unstable chronic HF patients, baseline values and follow-up measures of copeptin, midregional proadrenomedullin, C-terminal endothelin-1 precursor fragment, midregional proatrial natriuretic peptide, and B-type natriuretic peptide were equally predictive of all-cause mortality. Relative change of neurohormone values was noncontributory.
authors.affiliation: Department of Cardiology, Medical University Vienna, Austria.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Neuhold
authors.forename: Martin
authors.initials: M
authors.lastname: Huelsmann
authors.forename: Guido
authors.initials: G
authors.lastname: Strunk
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Gouya
authors.forename: Marie
authors.initials: M
authors.lastname: Elhenicky
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D002908:Chronic Disease; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018377:Neurotransmitter Agents / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood
chemical_list: D019332:Endothelin-1; D006020:Glycopeptides; D018377:Neurotransmitter Agents; D011498:Protein Precursors; C048197:copeptins; C088633:proadrenomedullin; C093240:proendothelin 1; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor