PLASMA NORADRENALINE AND THE PROGNOSIS OF CHRONIC CARDIAC-FAILURE - AMULTICENTER STUDY

Plasma noradrenaline is little used in evaluating the prognosis of car diac failure because of the theoretical necessity of interrupting trea tment for a few days before blood sampling. The present study reevalua ted the prognostic value of this parameter with blood sampling perform ed during treatment and then 48 hours after withdrawal of treatment in 192 patients with chronic stable cardiac failure at an advanced stage (64 % of patients in Classes III or IV with an average ejection fract ion of 28.5 +/- 13.5 %). During follow-up (average 43 months) there we re 51 deaths and 17 transplants. None of the patients were lost to fol low-up. Univariate analysis of 52 variable observers during the initia l phase of evaluation found in decreasing order of predictive value fo r death plasma noradrenaline levels before and after withdrawal of tre atment for 48 hours, Serum sodium, age, systolic mean and diastolic pu lmonary artery pressures. In multivariate analysis : noradrenaline wit h or without withdrawal of treatment, hyponatraemia and systolic pulmo nary artery pressure. Actuarial survival curves distinguished the foll owing parameters : noradrenaline levels became predictive at concentra tions of over 210 pg/mL and there was a significant difference in surv ival with respect to 4 levels of serum noradrenaline (with or without treatment) >300 pg/mL, 300 to 600 pg/mL and >900 pg/mL. This serum nor adrenaline measured without withdrawal of treatment (especially angiot ensin converting enzyme inhibitors) is a powerful predictor of mortali ty, carrying a progressively poorer prognosis as the concentration inc reases.