RELATIONSHIPS BETWEEN PLASMA-LEVELS OF CATECHOLAMINES AND NEUROPEPTIDES AND THE SURVIVAL-TIME IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

Objectives. To evaluate the importance of various variables reflecting neuroendocrine activation in relation to prognosis in patients with c ongestive heart failure (CHF). Design. Plasma levels of noradrenaline, adrenaline, neuropeptide Y, substance P, calcitonin gene-related pept ide, vasopressin and atrial natriuretic peptide were measured in patie nts presenting with CHF and related to survival time. Survival time wa s calculated from the time-point of this investigation until the month when the patient died or until December 1992. The follow-up period ra nged up to 60 months. Seven of the 31 patients were still alive at the end of this period. Setting. Lund University Hospital, Sweden. Subjec ts. Thirty-one patients with CHF due to ischaemic heart disease. Six p atients had a degree of heart failure corresponding to NYHA I-II and 2 5 corresponding to NYHA III-IV, Ten of these 25 patients were on angio tensin converting enzyme (ACE) inhibition in addition to therapy with digoxin and diuretics. The catecholamine and neuropeptide levels were compared to those of a control group of 31 healthy subjects aged 20-80 years. Intervention. There were not any specific intervention in addi tion to the treatment for heart failure as outlined above. Main outcom e measures. Survival time until death from heart disease or until the end of the follow up period in December 1992. Results, There were inve rse relationships between survival time on one hand and plasma values of noradrenaline (r = -0.49; P < 0.01) and atrial natriuretic peptide (r = -0.49; P < 0.01) on the other hand. There was a significant corre lation between the plasma values of noradrenaline and atrial natriuret ic peptide (r = 0.50; P < 0.01). Conclusion. Increased plasma levels o f noradrenaline and atrial natriuretic peptide are of major importance as prognostic markers in patients with CHF.