Abstract 12692: Plasma Adrenocorticotropic Hormone as a Useful Predictor of Prognosis in Patients With Acute Decompensated Heart Failure
Background: Both higher plasma aldosterone and cortisol concentrations were associated with increased mortality and rehospitalization rates in patients with chronic heart failure. We evaluated the prognostic value using adrenocorticotropic Hormone (ACTH) levels in acute decompensated heart failure (ADHF), in comparison with aldosterone and cortisol.
Methods: This study was prospective prognostic study performed as part of screening for NARA-HF3 study between April 2011 and December 2012. We measured the plasma levels of ACTH, aldosterone and serum cortisol on admission, in 154 ADHF patients, and we followed these patients for a median period of 442 days. Based on receiver operating characteristic (ROC) analysis, patients were divided into two groups: Hi-ACTH group, ACTH≥34.7 pg/ml (n=87); Lo-ACTH group, ACTH<34.7 pg/ml (n=67).
Results: Overall, the mean ages were 73.7 years and 60.4% were male and 39 (25.3%) patients died: 29 (18.8%) from cardiovascular causes. Hi-ACTH group patients were more likely to be men (68.5% vs. 45.8%, p=0.0036), cortisol levels were significantly higher in Hi-ACTH group than in Lo-ACTH group (22.6±13.7 μg/dl vs. 14.7±6.3 μg/dl, p<0.0001), but there was no significant difference in age, eGFR, LVEF, BNP and aldosterone levels both groups. Hi-ACTH and high levels of cortisol (above a cutoff value of 16.7 μg/dl derived from ROC analyses) were found to be associated with mortality (ACTH, 13.4% vs 34.5%, log-rank P=0.0019; cortisol, 16.7% vs 35.2%, log-rank P=0.0263) (Figure A, B), whereas aldosterone levels (above a cutoff of 54.6 pg/ml) did not predict mortality. Multivariate analyses showed that Hi-ACTH was the most potent predictor of mortality (HR 2.47, 95% CI 1.12 to 6.06, p<0.05).
Conclusions: Higher plasma levels of ACTH were independent predictors of increased mortality risk.
Author Disclosures: R. Kawakami: None.
- © 2014 by American Heart Association, Inc.