title: Prognostic value of aldosterone and cortisol in patients hospitalized for acutely decompensated chronic heart failure with and without mineralocorticoid receptor antagonism.
abstract: BACKGROUND
  Serum aldosterone and cortisol independently predict an increased mortality risk in heart failure (HF), and mineralocorticoid receptor antagonism (MRA) improves survival. The prognostic relevance of aldosterone and cortisol with MRA is unclear.
  
  
  RESULTS
  In this post hoc analysis of a prospective cohort, study serum levels of aldosterone and cortisol were measured at baseline in 842 patients with systolic HF. The mean age was 68 ± 12 years (27% female, 45% in New York Heart Association functional class III/IV, 43% with MRA; median follow-up 38 months [interquartile range 30-43 mo]). Crude mortality in the total cohort was 43% (patients with vs without MRA: 34% vs 41%; P = .052). In MRA-naïve patients, higher levels of both aldosterone and cortisol were predictive of increased mortality risk in multivariable Cox regression: hazard ratio (HR) with 95% confidence interval of highest vs lowest tertile for aldosterone: 1.51 [1.02-2.24] (P = .040); and for cortisol: 1.94 [1.28-2.93] (P = .002). In MRA-treated patients, aldosterone (highest vs lowest tertile: HR 1.65 [1.01-2.71]; P = .048) but not cortisol (HR 0.77 [0.44-1.27]; P = .33) was associated with all-cause mortality. Further subgroup analysis revealed that particularly patients with low cortisol and high aldosterone levels had the worst prognosis (HR 5.01 [2.22-11.3]; P < .001), compared with the reference of low cortisol and low aldosterone. Subjects with this profile had larger ventricles and more often coronary artery disease.
  
  
  CONCLUSIONS
  In systolic HF, the prognostic value of aldosterone and cortisol levels differs in dependency of MRA intake. The pathophysiologic link between low cortisol, high aldosterone, and increased mortality risk in patients with MRA needs to be clarified.
authors.affiliation: Cardiology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors.forename: Gülmisal
authors.initials: G
authors.lastname: Güder
authors.affiliation: Cardiology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Hammer
authors.affiliation: Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Deutschbein
authors.affiliation: Cardiology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Brenner
authors.affiliation: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Department of Cardiology and Angiology, Center for Internal Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Berliner
authors.affiliation: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: NiKolas
authors.initials: N
authors.lastname: Deubner
authors.affiliation: Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, Klinikum der LMU, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.affiliation: Cardiology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.affiliation: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.affiliation: Cardiology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors.forename: Christiane E
authors.initials: CE
authors.lastname: Angermann
authors.affiliation: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, Klinikum der LMU, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.affiliation: Cardiology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. Electronic address: stoerk_s@ukw.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Störk
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000450:Aldosterone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015331:Cohort Studies; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D006760:Hospitalization / Q000639:trends; D006854:Hydrocortisone / Q000097:blood; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011379:Prognosis
chemical_list: D000450:Aldosterone; D015415:Biomarkers; D006854:Hydrocortisone; D000451:Mineralocorticoid Receptor Antagonists
keywords: Heart failure; aldosterone; cortisol; mineralocorticoid antagonism; prognosis