Abstract 12658: Humoral Activation in Decompensated Heart Failure with Preserved or Reduced Ejection Fraction
Introduction: Heart failure (HF) may be associated with preserved (HFpEF) or reduced (HFrEF) ejection fraction. Acute HF decompensation (AHF) is associated with impaired renal hemodynamics and activation of the renin-angiotensin-aldosterone system (RAAS) promoting oxidative stress and a pro-fibrotic state. Volume overload in AHF increases natriuretic peptides (NP) which preserve renal blood flow, suppress aldosterone and oppose oxidative stress and fibrosis. Previous studies suggest that NP levels are lower in HFpEF than HFrEF. We hypothesized that blunted NP release in HFpEF may be associated with worse renal function, RAAS activation, oxidative stress and fibrosis.
Methods: In patients with chronic HF (outpatient furosemide dose 80–240 mg/day) hospitalized with AHF and enrolled in the Diuretic Optimization Strategies Evaluation (DOSE) study, NT-proBNP, renal function (cystatin C), RAAS activation (aldosterone), oxidative stress (uric acid) and a marker of collagen turnover (Procollagen Type III N-terminal peptide, PIIINP) were measured at study entry (<24 hrs after admission) and compared in HFpEF (EF≥50%;, n=81) and HFrEF (n=219). Analysis used log-transformation and adjustment for pertinent covariates as appropriate.
Results: HFpEF patients were older (72±11 vs 64±14 yrs, p<0.001), more likely female (p<0.001), had higher BMI (p=0.02), more rales (68.7% vs 55.5%, p=0.007) and higher systolic blood pressure (124±22 vs 117±19 mmHg, p=0.008) but similar NYHA class, edema and orthopnea severity (p>0.05 for all). HFpEF patients had lower NT-proBNP but cystatin C, aldosterone, uric acid and PIIINP levels were similar (table).
Conclusions: HFpEF patients had lower NT-proBNP levels than HFrEF patients despite similar-worse AHF severity. Despite this, HFpEF and HFrEF patients display similar severity of renal dysfunction, RAAS activation, oxidative stress and pro-fibrotic collagen turnover.
- © 2010 by American Heart Association, Inc.