Abstract 12451: The Plasma Renin Activity in Acute Phases in Patients with Acute Heart Failure Syndromes Predicts the Long-term Clinical Outcome
Background: Although cardio-renal surrogate markers were reported as predictive factors in patients with chronic heart failure, the importance of these markers in an acute phase in patients with acute heart failure syndromes (AHFS) has not been established. We investigated the relation between either plasma renin activity (PRA) or BNP levels in acute phases, and long-term prognosis in patients with AHFS.
Methods: We have retrospectively studied consecutive 117 patients with AHFS admitted to our department from 2005 August through 2011 February, whose PRA, BNP and aldosterone levels of the blood were measured within 6 days after the admission. Cardiovascular events were defined as either cardiovascular death or re-hospitalization due to heart failure.
Result: Of 117 patients with AHFS, mean PRA was 8.5±12.0 ng/ml/hr and cut-off value was set at 5.3 ng/ml/hr by the analysis of ROC curve. PRA was not related to the BNP value at admission (Figure 1). Kaplan-Meier analysis revealed that the patients with high PRA (>5.3 ng/ml/hr, n=71, Group H) had worse prognosis (p<0.001) than those with low PRA (<5.3 ng/ml/hr, n=46, Group L)(Figure 2A), but BNP levels at admission could not predict the prognosis (Figure 2B). Univariate analysis revealed that PRA predicted cardiac events (hazard ratio [HR]: 1.03 [1.01-1.05], p=0.003), but not log BNP levels at admission (hazard ratio [HR]: 1.03 [0.54-2.03], p=0.94). The ratio of patients receiving aldosterone antagonists was higher in Group H than Group L, the results were comparable in the patients treated with aldosterone antagonists. There were no differences in the use of other renin-angiotensin aldosterone blockers. Systolic blood pressure and eGFR were lower in Group H than Group L.
Conclusion: The high plasma renin activity at the acute phase in patients with acute heart failure syndromes predicts the long-term clinical outcome independent from BNP levels. This result might be the reflection of the cardio-renal linkage.
- © 2012 by American Heart Association, Inc.