The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT

Roberto Latini, Serie Masson, Inder Anand, Monica Salio, Allen Hester, Dianne Judd, Simona Barlera, Aldo P. Maggioni, Gianni Tognoni, Jay N. Cohn

Research output: Contribution to journalArticle

289 Citations (Scopus)

Abstract

Aims: Plasma levels of individual neurohormones (NH) have been proposed as reliable indicators for risk stratification of patients with heart failure (HF). Mainly because of small sample size, the predictive value of different NH has never been compared, while taking into account demosraphic, clinical and echocardiographic markers of risk in HF. Methods and results: Plasma brain natriuretic peptide (BNP), norepinephrine (NE), renin activity (PRA), aldosterone (aldo) and endothelin were measured in 4300 patients before randomization in Val-HeFT. Univariate and multivariate Cox proportional hazard analyses were performed to investigate the relationship between NH and two primary study outcomes, mortality and combined mortality and morbidity (M/M). Higher baseline values for all NH were related to mortality and M/M, with univariate hazard ratios ranging from 1.13 [95% CI 0.99-1.30] (aldo) to 2.47 [2.13-2.87] (BNP) for mortality, and from 1.24 [1.11-1.39] (aldo) to 2.56 [2.28-2.89] (BNP) for M/M. In multivariate analyses, BNP had the strongest association with outcome, followed by NE and PRA. Patients with more activation of renin-angiotensin-aldosterone system tended to show greater benefit from valsartan; but the trend was not statistically significant. Conclusion: All the NHs evaluated in 4300 patients with stable moderate to severe HF were found to be significant markers of outcome, despite therapy with ACEi, BB and randomization to an angiotensin receptor blocker or placebo. Several of these markers have been implicated as contributors to progression of HF, but BNP, which is thought to be protective, was the most powerful indicator for poor outcome.

Original languageEnglish (US)
Pages (from-to)292-299
Number of pages8
JournalEuropean heart journal
Volume25
Issue number4
DOIs
StatePublished - Feb 1 2004

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Brain Natriuretic Peptide
Neurotransmitter Agents
Heart Failure
Aldosterone
Mortality
Norepinephrine
Valsartan
Random Allocation
Renin
Morbidity
Angiotensin Receptor Antagonists
Endothelins
Renin-Angiotensin System
Sample Size
Multivariate Analysis
Biomarkers
Placebos
Outcome Assessment (Health Care)

Keywords

  • Aldosterone
  • Brain natriuretic peptide
  • Endothelin
  • Heart failure
  • Neurohormones
  • Norepinephrine
  • Outcome
  • Renin

Cite this

The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT. / Latini, Roberto; Masson, Serie; Anand, Inder; Salio, Monica; Hester, Allen; Judd, Dianne; Barlera, Simona; Maggioni, Aldo P.; Tognoni, Gianni; Cohn, Jay N.

In: European heart journal, Vol. 25, No. 4, 01.02.2004, p. 292-299.

Research output: Contribution to journalArticle

Latini, R, Masson, S, Anand, I, Salio, M, Hester, A, Judd, D, Barlera, S, Maggioni, AP, Tognoni, G & Cohn, JN 2004, 'The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT', European heart journal, vol. 25, no. 4, pp. 292-299. https://doi.org/10.1016/j.ehj.2003.10.030
Latini, Roberto ; Masson, Serie ; Anand, Inder ; Salio, Monica ; Hester, Allen ; Judd, Dianne ; Barlera, Simona ; Maggioni, Aldo P. ; Tognoni, Gianni ; Cohn, Jay N. / The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT. In: European heart journal. 2004 ; Vol. 25, No. 4. pp. 292-299.
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AU - Latini, Roberto

AU - Masson, Serie

AU - Anand, Inder

AU - Salio, Monica

AU - Hester, Allen

AU - Judd, Dianne

AU - Barlera, Simona

AU - Maggioni, Aldo P.

AU - Tognoni, Gianni

AU - Cohn, Jay N.

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