NEUROENDOCRINE ACTIVATION IN RELATION TO LEFT-VENTRICULAR FUNCTION INCHRONIC SEVERE CONGESTIVE-HEART-FAILURE - A SUBGROUP ANALYSIS FROM THE COOPERATIVE NORTH SCANDINAVIAN ENALAPRIL SURVIVAL STUDY (CONSENSUS)

Left ventricular (LV) function and plasma levels of cardiovascular hor mones were examined in patients with severe chronic congestive heart f ailure (CHF), randomized to placebo or enalapril, in addition to conve ntional therapy. M-mode echocardiography and plasma hormone concentrat ions were available at baseline and after 6 weeks of treatment. There was a significant relationship between LV systolic function and levels of angiotensin-II and norepinephrine. Enalapril increased LV fraction al shortening (FS%) (13.3 +/- 5.6 to 15.4 +/- 5.8, p < 0.05) and decre ased the systolic time interval index (0.58 +/- 0.14 to 0.48 +/- 0.15, p < 0.05) concurrent with a significant decrease in angiotensin-conve rting enzyme activity and in aldosterone, angiotensin-II, and norepine phrine concentrations after 6 weeks. No changes were found in the plac ebo group. However, there was no direct relationship between the amoun t of change in neurohormones and improvement in LV function after 6 we eks. These findings indicate that in patients with severe chronic CHF, severe LV systolic dysfunction is associated with high plasma levels of angiotensin-II and norepinephrine, which can be favorably modified by enalapril. This may be of importance for prolonging life in severe heart failure. The lack of relationship between changes in individual hormones and systolic function suggests complex dynamic interaction. I t is, therefore, not sufficient to predict changes in LV function by m easuring changes in only one hormone.