Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure
Abstract Aims Activation of the renin–angiotensin–aldosterone system plays an important role in the pathophysiology of heart failure (HF) and has been associated with poor prognosis. There are limited data on the associations of renin and aldosterone levels with clinical profiles, treatment response...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-06-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12634 |
| _version_ | 1818436607124963328 |
|---|---|
| author | Masatake Kobayashi Susan Stienen Jozine M. terMaaten Kenneth Dickstein Nilesh J. Samani Chim C. Lang Leong L. Ng Stefan D. Anker Macro Metra Gregoire Preud'homme Kevin Duarte Zohra Lamiral Nicolas Girerd Patrick Rossignol Dirk J. vanVeldhuisen Adriaan A. Voors Faiez Zannad João Pedro Ferreira |
| author_facet | Masatake Kobayashi Susan Stienen Jozine M. terMaaten Kenneth Dickstein Nilesh J. Samani Chim C. Lang Leong L. Ng Stefan D. Anker Macro Metra Gregoire Preud'homme Kevin Duarte Zohra Lamiral Nicolas Girerd Patrick Rossignol Dirk J. vanVeldhuisen Adriaan A. Voors Faiez Zannad João Pedro Ferreira |
| author_sort | Masatake Kobayashi |
| collection | DOAJ |
| description | Abstract Aims Activation of the renin–angiotensin–aldosterone system plays an important role in the pathophysiology of heart failure (HF) and has been associated with poor prognosis. There are limited data on the associations of renin and aldosterone levels with clinical profiles, treatment response, and study outcomes in patients with HF. Methods and results We analysed 2,039 patients with available baseline renin and aldosterone levels in BIOSTAT‐CHF (a systems BIOlogy study to Tailored Treatment in Chronic Heart Failure). The primary outcome was the composite of all‐cause mortality or HF hospitalization. We also investigated changes in renin and aldosterone levels after administration of mineralocorticoid receptor antagonists (MRAs) in a subset of the EPHESUS trial and in an acute HF cohort (PORTO). In BIOSTAT‐CHF study, median renin and aldosterone levels were 85.3 (percentile25–75 = 28–247) μIU/mL and 9.4 (percentile25–75 = 4.4–19.8) ng/dL, respectively. Prior HF admission, lower blood pressure, sodium, poorer renal function, and MRA treatment were associated with higher renin and aldosterone. Higher renin was associated with an increased rate of the primary outcome [highest vs. lowest renin tertile: adjusted‐HR (95% CI) = 1.47 (1.16–1.86), P = 0.002], whereas higher aldosterone was not [highest vs. lowest aldosterone tertile: adjusted‐HR (95% CI) = 1.16 (0.93–1.44), P = 0.19]. Renin and/or aldosterone did not improve the BIOSTAT‐CHF prognostic models. The rise in aldosterone with the use of MRAs was observed in EPHESUS and PORTO studies. Conclusions Circulating levels of renin and aldosterone were associated with both the disease severity and use of MRAs. By reflecting both the disease and its treatments, the prognostic discrimination of these biomarkers was poor. Our data suggest that the “point” measurement of renin and aldosterone in HF is of limited clinical utility. |
| first_indexed | 2024-12-14T17:11:28Z |
| format | Article |
| id | doaj.art-082e346595f54e1fb895891398326afa |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T17:11:28Z |
| publishDate | 2020-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-082e346595f54e1fb895891398326afa2022-12-21T22:53:32ZengWileyESC Heart Failure2055-58222020-06-017395396310.1002/ehf2.12634Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failureMasatake Kobayashi0Susan Stienen1Jozine M. terMaaten2Kenneth Dickstein3Nilesh J. Samani4Chim C. Lang5Leong L. Ng6Stefan D. Anker7Macro Metra8Gregoire Preud'homme9Kevin Duarte10Zohra Lamiral11Nicolas Girerd12Patrick Rossignol13Dirk J. vanVeldhuisen14Adriaan A. Voors15Faiez Zannad16João Pedro Ferreira17INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceDepartment of Cardiology University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Internal Medicine University of Bergen Bergen NorwayDepartment of Cardiovascular Sciences University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital Leicester UKDivision of Molecular and Clinical Medicine, School of Medicine University of Dundee, Ninewells Hospital & Medical School Dundee UKDepartment of Cardiovascular Sciences University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital Leicester UKDepartment of Cardiology (CVK) Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin Berlin GermanyDepartment of Cardiology University and Civil hospitals of Brescia Brescia ItalyINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceDepartment of Cardiology University of Groningen, University Medical Center Groningen Groningen The NetherlandsDepartment of Cardiology University of Groningen, University Medical Center Groningen Groningen The NetherlandsINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceINSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F‐CRIN INI‐CRCT Université de Lorraine Nancy FranceAbstract Aims Activation of the renin–angiotensin–aldosterone system plays an important role in the pathophysiology of heart failure (HF) and has been associated with poor prognosis. There are limited data on the associations of renin and aldosterone levels with clinical profiles, treatment response, and study outcomes in patients with HF. Methods and results We analysed 2,039 patients with available baseline renin and aldosterone levels in BIOSTAT‐CHF (a systems BIOlogy study to Tailored Treatment in Chronic Heart Failure). The primary outcome was the composite of all‐cause mortality or HF hospitalization. We also investigated changes in renin and aldosterone levels after administration of mineralocorticoid receptor antagonists (MRAs) in a subset of the EPHESUS trial and in an acute HF cohort (PORTO). In BIOSTAT‐CHF study, median renin and aldosterone levels were 85.3 (percentile25–75 = 28–247) μIU/mL and 9.4 (percentile25–75 = 4.4–19.8) ng/dL, respectively. Prior HF admission, lower blood pressure, sodium, poorer renal function, and MRA treatment were associated with higher renin and aldosterone. Higher renin was associated with an increased rate of the primary outcome [highest vs. lowest renin tertile: adjusted‐HR (95% CI) = 1.47 (1.16–1.86), P = 0.002], whereas higher aldosterone was not [highest vs. lowest aldosterone tertile: adjusted‐HR (95% CI) = 1.16 (0.93–1.44), P = 0.19]. Renin and/or aldosterone did not improve the BIOSTAT‐CHF prognostic models. The rise in aldosterone with the use of MRAs was observed in EPHESUS and PORTO studies. Conclusions Circulating levels of renin and aldosterone were associated with both the disease severity and use of MRAs. By reflecting both the disease and its treatments, the prognostic discrimination of these biomarkers was poor. Our data suggest that the “point” measurement of renin and aldosterone in HF is of limited clinical utility.https://doi.org/10.1002/ehf2.12634Heart failureReninAldosteronePrediction modelPrognosis |
| spellingShingle | Masatake Kobayashi Susan Stienen Jozine M. terMaaten Kenneth Dickstein Nilesh J. Samani Chim C. Lang Leong L. Ng Stefan D. Anker Macro Metra Gregoire Preud'homme Kevin Duarte Zohra Lamiral Nicolas Girerd Patrick Rossignol Dirk J. vanVeldhuisen Adriaan A. Voors Faiez Zannad João Pedro Ferreira Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure ESC Heart Failure Heart failure Renin Aldosterone Prediction model Prognosis |
| title | Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure |
| title_full | Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure |
| title_fullStr | Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure |
| title_full_unstemmed | Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure |
| title_short | Clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure |
| title_sort | clinical determinants and prognostic implications of renin and aldosterone in patients with symptomatic heart failure |
| topic | Heart failure Renin Aldosterone Prediction model Prognosis |
| url | https://doi.org/10.1002/ehf2.12634 |
| work_keys_str_mv | AT masatakekobayashi clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT susanstienen clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT jozinemtermaaten clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT kennethdickstein clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT nileshjsamani clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT chimclang clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT leonglng clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT stefandanker clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT macrometra clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT gregoirepreudhomme clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT kevinduarte clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT zohralamiral clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT nicolasgirerd clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT patrickrossignol clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT dirkjvanveldhuisen clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT adriaanavoors clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT faiezzannad clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure AT joaopedroferreira clinicaldeterminantsandprognosticimplicationsofreninandaldosteroneinpatientswithsymptomaticheartfailure |