Prognostic value of neurohormonal activation and cardiopulmonary exercise testing in patients with chronic heart failure

We compared the value of plasma neurohormones and cardiopulmonary exercise testing for predicting longterm prognosis in patients with moderate congest ive heart failure (CHF). We studied 264 consecutive patients with CHF due t o left ventricular systolic dysfunction. Plasma atrial natriuretic peptide (ANP), norepinephrine, and endothelin-l were measured at rest in all patien ts, who also underwent a symptom-limited maximal exercise with oxygen consu mption (VO2) determination. After a median follow-up of 789 days, 52 deaths and 31 heart transplantations occurred, of which 4 were urgent. In an univ ariate analysis, New York Heart Association functional class, systolic bloo d pressure at rest, left ventricular end-diastolic diameter, left ventricul ar ejection fraction, peak VO2, percent of predicted peak VO2, plasma ANP, plasma norepinephrine, and plasma endothelin-1 were associated with surviva l without urgent heart transplantation. In a multivariate stepwise regressi on analysis, only plasma ANP (p = 0.0001), left ventricular ejection fracti on (p = 0.007), and plasma norepinephrine (p = 0.035), but neither peak VO2 nor percentage of predicted peak VO2, were independent predictors of death or urgent heart transplantation. Determination of plasma ANP and norepinep hrine provides additional independent information for long-term prognostic determination compared with exercise testing alone. Measurement of plasma n eurohormones should therefore be considered routinely as a complementary or alternative tool for identifying high-risk patients with moderate CHF. (C) 2000 by Excerpta Medica, Inc.