TY - JOUR
T1 - Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure
T2 - A substudy of the Studies of Left Ventricular Dysfunction (SOLVD)
AU - Francis, Gary S.
AU - Benedict, Claude
AU - Johnstone, David E.
AU - Kirlin, Philip C.
AU - Nicklas, John
AU - Liang, Chang Seng
AU - Kubo, Spencer H.
AU - Rudin-Toretsky, Elizabeth
AU - Yusuf, Salim
PY - 1990/11
Y1 - 1990/11
N2 - Neuroendocrine activation is known to occur in patients with congestive heart failure, but there is uncertainty as to whether this occurs before or after the presence of overt symptoms. In the Studies of Left Ventricular Dysfunction (SOLVD), a multicenter study of patients with ejection fractions of 35% or less, we compared baseline plasma norepinephrine, plasma renin activity, plasma atrial natriuretic factor, and plasma arginine vasopressin in 56 control subjects, 151 patients with left ventricular dysfunction (no overt heart failure), and 81 patients with overt heart failure before randomization. Median values for plasma norepinephrine (p=0.0001), plasma atrial natriuretic factor (p<0.0001), plasma arginine vasopressin (p=0.006), and plasma renin activity (p=0.03) were significantly higher in patients with left ventricular dysfunction than in normal control subjects. Neuroendocrine values were highest in patients with overt heart failure. Plasma renin activity was normal in patients with left ventricular dysfunction without heart failure who were not receiving diuretics and was significantly increased (p<0.05) in patients on diuretic therapy. We conclude that neuroendocrine activation occurs in patients with left ventricular dysfunction and no heart failure. Neuroendocrine activation is further increased as overt heart failure ensues and diuretics are added to therapy.
AB - Neuroendocrine activation is known to occur in patients with congestive heart failure, but there is uncertainty as to whether this occurs before or after the presence of overt symptoms. In the Studies of Left Ventricular Dysfunction (SOLVD), a multicenter study of patients with ejection fractions of 35% or less, we compared baseline plasma norepinephrine, plasma renin activity, plasma atrial natriuretic factor, and plasma arginine vasopressin in 56 control subjects, 151 patients with left ventricular dysfunction (no overt heart failure), and 81 patients with overt heart failure before randomization. Median values for plasma norepinephrine (p=0.0001), plasma atrial natriuretic factor (p<0.0001), plasma arginine vasopressin (p=0.006), and plasma renin activity (p=0.03) were significantly higher in patients with left ventricular dysfunction than in normal control subjects. Neuroendocrine values were highest in patients with overt heart failure. Plasma renin activity was normal in patients with left ventricular dysfunction without heart failure who were not receiving diuretics and was significantly increased (p<0.05) in patients on diuretic therapy. We conclude that neuroendocrine activation occurs in patients with left ventricular dysfunction and no heart failure. Neuroendocrine activation is further increased as overt heart failure ensues and diuretics are added to therapy.
KW - Clinical trials
KW - Congestive heart failure
KW - Hormones
KW - Left ventricular dysfunction
KW - Neuroendocrine
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U2 - 10.1161/01.CIR.82.5.1724
DO - 10.1161/01.CIR.82.5.1724
M3 - Review article
C2 - 2146040
AN - SCOPUS:0025153828
SN - 0009-7322
VL - 82
SP - 1724
EP - 1729
JO - Circulation
JF - Circulation
IS - 5
ER -