Author + information
- Received August 8, 1988
- Revision received November 22, 1988
- Accepted January 9, 1989
- Published online June 1, 1989.
- Stephen S. Gottlieb, M, FACC∗,
- Marrick L. Kukin, MD, FACC,
- Deborah Ahern, RN and
- Milton Packer, MD, FACC
- ↵∗Current address and address for reprints: Stephen S. Gottlieb, MD, Division of Cardiology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Maryland 21201.
Several circulating neurohormones have been shown to have prognostic significance in patients with chronic heart failure, but the relation between plasma levels of atrial natriuretic peptide and mortality in this disorder remains unknown. Plasma levels of immunoreactive atrial natriuretic peptide were measured in 102 patients in whom left ventricular ejection fraction, ventricular arrhythmias on ambulatory electrocardiographic recording and plasma levels of norepinephrine, renin activity, aldosterone and arginine vasopressin were also measured. Compared with patients with atrial natriuretic peptide concentrations below the median value of 125 pg/ml, patients with higher levels of the peptide had a higher plasma renin activity (8.9 ± 1.8 versus 2.6 ± 0.4 ng/ml per h) and plasma norepinephrine (858 ± 116 versus 538 ± 45 pg/ml), more frequent premature ventricular depolarizations (4,485 ± 715 versus 2,004 ± 495/day) and more advanced hemodynamic abnormalities (all p < 0.05).
During the subsequent 13 to 25 months of follow-up, patients with high levels of atrial natriuretic peptide had a significantly lower rate of survival than did those whose initial circulating peptide concentrations were normal or mildly increased (p = 0.01). These data indicate that, in patients with chronic heart failure, plasma atrial natriuretic peptide provides important prognostic information. This may relate to the ability of the hormone to reflect the interplay of several pathophysiologic factors that contribute to mortality in this disease.
☆ This study was supported by grants T32 HL 07347 and R01-HL-25055 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. Dr. Packer is the recipient of a Research Career Development Award (K04-HL 01229) from the National Institutes of Health.
- Received August 8, 1988.
- Revision received November 22, 1988.
- Accepted January 9, 1989.