Abstract 5915: Clinical and Neurohormonal Correlates and Prognostic Value of Serum Prolactin Levels in Patients with Chronic Heart Failure
Hypothalamic axis dysregulation is associated with the clinical severity of chronic heart failure (CHF) and the presence of depression. We sought to investigate the relationship of serum prolactin levels with neurohomonal/immune activation and depressive symptoms and their prognostic value in patients with CHF. Serum prolactin was measured in 180 CHF patients (aged 65±12 years, mean left ventricular ejection fraction 27±7%). Plasma B-type natriuretic peptide (BNP), inflammatory cytokines, endothelial adhesion molecules, 6-minute walking test (6MWT) and Zung self-rating depression scale (SDS) were also assessed. Patients were followed for major cardiovascular events, including death or hospitalization, for up to 8 months. Prolactin levels were significantly correlated with New York Heart Association (NYHA) class (r=0.394, p<0.001), left ventricular ejection fraction (r=−0.314, p<0.001), 6MWT (r=−0.353, p<0.001), BNP (r=0.374, p<0.001), Zung SDS (r=0.544, p<0.001), interleukin (IL)-6 (r=0.451, p<0.001), IL-10 (r=−0.426, p<0.001), tumor necrosis factor (TNF)-α (r=0.310, p=0.001), Fas (r=0.333, p<0.001), Fas-ligand (r=0.517, p<0.001), ICAM (r=0.409, p<0.001) and VCAM (r=0.480, p<0.001). During follow-up, 119 patients (66%) experienced an event after a median time of 72 days (range, 5–220 days). Patients with an eventful course had higher prolactin levels (10.2±5.7 vs 6.7±4.3 ng/ml, p<0.001). Prolactin predicted the occurrence of events with an area under the curve of 0.653 [standard error (SE), 0.061; 95% confidence intervals (CI), 0.534 – 0.773; p=0.015). Patients with a baseline prolactin levels >4.5 ng/mL had a significantly lower event-free survival (116±7 vs 181±11 days, p=0.0001). In multivariate Cox regression analysis, prolactin levels remained an independent predictor of events (<4.5 vs >4.5 ng/mL; odds ratio, 0.368; 95% CI, 0.148 – 0.913; p=0.031), along with BNP (p<0.001) and 6MWT (p=0.020). Serum prolactin is closely associated with neurohormonal/immune activation and depressive symptoms, while it is also an independent predictor of long-term prognosis in CHF patients.