title: The predictability of renin-angiotensin-aldosterone system factors for clinical outcome in patients with acute decompensated heart failure.
abstract: Although counter-regulation between B-type natriuretic peptide (BNP) levels and renin-angiotensin-aldosterone system (RAAS) activation in heart failure (HF) has been suggested, whether the regulation is preserved in acute decompensated heart failure (ADHF) patients remains unclear. This study aimed to determine: (1) the relationship between RAAS activation and clinical outcomes in ADHF patients, and (2) the relationships between plasma BNP levels and degrees of activation in RAAS factors. This study included ADHF patients (n = 103, NYHA3-4, plasma BNP > 200 pg/ml). We studied the predictability of RAAS factors for cardiovascular events and the relationships between plasma BNP levels and the degrees of activation in RAAS factors, which were evaluated by plasma renin activity (PRA) and aldosterone concentration (PAC). PRA was a strong predictor of cardiovascular (CV) events over 1 year, even after accounting for plasma BNP levels (hazard ratio (HR): 1.04, CI [1.02-1.06], p < 0.01) and medication such as RAAS blockers (HR: 1.03, CI [1.01-1.05], p < 0.01), whereas PAC was borderline-significant (univariate analysis, p = 0.06). Cut-off value of PRA (5.3 ng/ml/h) was determined by AUC curve. Of the enrolled patients, higher PRA was found in 40 % of them. Although no correlation between the plasma BNP levels and PRA was found (p = 0.36), after adjusting for hemodynamic parameters, eGFR and medication, a correlation was found between them (p = 0.01). Elevated RAAS factors were found in a substantial number of ADHF patients with high plasma BNP levels in the association with hemodynamic state, which predicts poor clinical outcomes. The measurements of RAAS factors help to stratify ADHF patients at risk for further CV events.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.|First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, 634-0813, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Nakada
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan. takahama@ncvc.go.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahama
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kanzaki
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sugano
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ohara
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Amaki
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Funada
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D012372:ROC Curve; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System; D012189:Retrospective Studies; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D012083:Renin
keywords: Acute decompensated heart failure; BNP; Renin–angiotensin–aldosterone system