Prognostic evaluation of neurohumoral plasma levels before and during beta-blocker therapy in advanced left ventricular dysfunction

Abstract OBJECTIVES The study assessed the relative predictive potency of neurohumoral factors in patients with advanced left ventricular (LV) dysfunction during neurohumoral blocking therapy. BACKGROUND The course of heart failure is characterized by progressive LV deterioration associated with an increase in cardiac (natriuretic peptides) and predominantly extracardiac (norepinephrine, big endothelin [big ET]) hormone plasma levels. METHODS Plasma hormones were measured at baseline and months 3, 6, 12 and 24 in 91 patients with heart failure (left ventricular ejection fraction [LVEF] RESULTS Thirty-one patients died from a cardiovascular cause during follow-up. At baseline, log BNP plasma level (x 2 = 13.9, p = 0.0002), treatment allocation (x 2 = 9.5, p = 0.002) and LVEF (x 2 = 5.6, p = 0.017) were independently related to mortality. During the study, log BNP plasma level (x 2 = 21.3, p = 0.0001) remained the strongest predictive marker, with LVEF (x 2 = 11.2, p = 0.0008) log N-BNP plasma level (x 2 = 8.9, p = 0.0027) and treatment allocation (x 2 = 6.4, p = 0.0109) providing additional independent information. CONCLUSIONS In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they will likely emerge as a very useful blood test for detection of the progression of heart failure, even in the face of neurohumoral blocking therapy.