Abstract 3608: In Chronic Heart Failure, Chronic Renal Failure May Increase Mortality Through Sympathetic Activation
Background: Sympathetic activation (SA) has a negative impact on survival in chronic heart failure (CHF). SA is present in chronic renal failure (CRF). We hypothesized that CRF increases mortality in CHF in part by leading to increased SA.
Methods: 2126 of 2708 patients enrolled in the BEST trial (comparing treatment with bucindolol to placebo in advanced CHF) had baseline plasma norepinephrine (PNE) level measured. Patients had mean (± SD) age of 60 years (±12), EF of 23% (±7), GFR of 69 cc/min/1.73 m2 (±25) using the MDRD formula. 80% were males, 70% Caucasians, 59% had CAD, 91% were in NYHA class III and 9% in class IV.
Results: PNE levels were higher in patients with low GFR (< 60 cc/min/1.73 m2) versus high GFR (≥ 60): 573 pg/ml (± 14) versus 480 (± 8), p > 0.0001. PNE levels correlated inversely with EF and GFR and directly with age. The contribution of EF and GFR to PNE levels was similar with a correlation coefficient r = −0.16 (p < 0.0001). Baseline GFR did not correlate with EF.
Conclusions: Our data show that: 1. PNE levels are higher in CHF patients with concomitant CRF. 2. GFR and EF contribute equally to PNE levels. 3. SA is a potential mechanism by which CRF contributes to increased mortality in CHF.