NEUROHORMONAL ACTIVATION IN PATIENTS WITH RIGHT-VENTRICULAR FAILURE FROM PULMONARY-HYPERTENSION - RELATION TO HEMODYNAMIC VARIABLES AND ENDOTHELIN LEVELS

Objectives. This study sought to determine whether neurohormonal activ ation occurs in isolated right heart failure. Background. Neurohormona l activation appears to parallel the severity of left heart failure, b ut little is known about its role in right heart failure. Methods. We evaluated neurohormonal activation and endothelin levels in 21 patient s,vith primary pulmonary hypertension at the time of right heart cathe terization. Results. Plasma norepinephrine levels correlated significa ntly with pulmonary artery pressure (r = 0.66, p < 0.01), cardiac inde x (r = -0.56, p < 0.01) and pulmonary vascular resistance (r = 0.69, p < 0.001). Atrial natriuretic peptide levels were higher in the pulmon ary artery than the right atrium and femoral artery and correlated clo sely with pulmonary artery oxygen saturation (r = -0.73, p < 0.0001). Plasma renin levels were not elevated. Endothelin levels were increase d and correlated with right atrial pressure (r = 0.74, p < 0.0001) and pulmonary artery oxygen saturation (r = -0.070, p < 0.0004). Conclusi ons. Neurohormonal activation occurs in patients with isolated right v entricular failure and inherently normal left ventricles and appears t o be related to the overall severity of cardiopulmonary derangements. The elevation in endothelin levels is consistent with its release in r esponse to pulmonary hypertension.