| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Circulation, Vol 73, 257-267, Copyright © 1986 by American Heart Association
WH Lee and M Packer
Although past reports have identified a variety of prognostic factors in
patients with severe chronic heart failure, previous studies have not
evaluated the interaction of prognostic variables and drug treatment. We
analyzed the association of 30 clinical, hemodynamic, and biochemical
variables with survival in 203 consecutive patients with severe heart
failure; all variables were assessed just before initiation of treatment
with a variety of vasodilator drugs, and all patients were subsequently
followed for 6 to 94 months. By regression analysis, pretreatment serum
sodium concentration was the most powerful predictor of cardiovascular
mortality, with hyponatremic patients having a substantially shorter median
survival than did patients with a normal serum sodium concentration (164 vs
373 days, p = .006). The unfavorable prognosis for hyponatremic patients
appeared to be related to the marked elevation of plasma renin activity
that we noted in these individuals (10.0 +/- 2.0 ng/ml/hr), since
hyponatremic patients fared significantly better when treated with
angiotensin converting-enzyme inhibitors than when treated with vasodilator
drugs that did not interfere with angiotensin II biosynthesis (median
survival 232 vs 108 days, p = .003). In contrast, there was no selective
benefit of converting-enzyme inhibition on the survival of patients with a
normal serum sodium concentration, in whom plasma renin activity was low
(1.9 +/- 0.3 ng/ml/hr). This interaction between serum sodium
concentration, drug treatment, and long-term outcome suggests that the
renin- angiotensin system may exert a deleterious effect on the survival of
some patients with chronic heart failure, which can be antagonized by
converting enzyme inhibition, and provides a clinical counterpart for the
similar prognostic role that has been postulated for angiotensin II in
experimental preparations of heart failure.
ARTICLES
Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure
This article has been cited by other articles:
 |
|
 |
|
  M. Sarraf, A. Masoumi, and R. W. Schrier Cardiorenal Syndrome in Acute Decompensated Heart Failure Clin. J. Am. Soc. Nephrol., December 1, 2009; 4(12): 2013 - 2026. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Dimopoulos, G.-P. Diller, R. Petraco, E. Koltsida, G. Giannakoulas, E. L. Tay, N. Best, M. F. Piepoli, D. P. Francis, P. A. Poole-Wilson, et al. Hyponatraemia: a strong predictor of mortality in adults with congenital heart disease Eur. Heart J., November 23, 2009; (2009) ehp495v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Chatterjee Analytic Review: Hyponatremia in Heart Failure J Intensive Care Med, November 1, 2009; 24(6): 347 - 351. [Abstract] [PDF]
|
|
|
|
 |
|
 P. R. Forfia, S. C. Mathai, M. R. Fisher, T. Housten-Harris, A. R. Hemnes, H. C. Champion, R. E. Girgis, and P. M. Hassoun Hyponatremia Predicts Right Heart Failure and Poor Survival in Pulmonary Arterial Hypertension Am. J. Respir. Crit. Care Med., June 15, 2008; 177(12): 1364 - 1369. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Schrier Blood Urea Nitrogen and Serum Creatinine: Not Married in Heart Failure Circ Heart Fail, May 1, 2008; 1(1): 2 - 5. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kazory and E. A. Ross Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure: A Nephrologic Perspective Circulation, February 19, 2008; 117(7): 975 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Milo-Cotter, G. Cotter, B. D. Weatherley, K. F. Adams, E. Kaluski, N. Uriel, C. M. O'Connor, and G. M. Felker Hyponatraemia in acute heart failure is a marker of increased mortality but not when associated with hyperglycaemia Eur J Heart Fail, February 1, 2008; 10(2): 196 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Gardner, K. S. Chong, E. O'Meara, A. Jardine, I. Ford, and T. A. McDonagh Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure Eur. Heart J., December 2, 2007; 28(24): 3027 - 3033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Ghali Hyponatraemia in heart failure: a call for redefinition Eur. Heart J., April 12, 2007; (2007) ehm046v1. [Full Text] [PDF]
|
|
|
|
|
|
M. Gheorghiade, W. T. Abraham, N. M. Albert, W. Gattis Stough, B. H. Greenberg, C. M. O'Connor, L. She, C. W. Yancy, J. Young, G. C. Fonarow, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry Eur. Heart J., April 2, 2007; 28(8): 980 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. deGoma, R. H. Vagelos, M. B. Fowler, and E. A. Ashley Emerging Therapies for the Management of Decompensated Heart Failure: From Bench to Bedside J. Am. Coll. Cardiol., November 28, 2006; (2006) j.jacc.2006.08.039v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Schrier, P. Gross, M. Gheorghiade, T. Berl, J. G. Verbalis, F. S. Czerwiec, C. Orlandi, and the SALT Investigators Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia N. Engl. J. Med., November 16, 2006; 355(20): 2099 - 2112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Schrier Body Water Homeostasis: Clinical Disorders of Urinary Dilution and Concentration J. Am. Soc. Nephrol., July 1, 2006; 17(7): 1820 - 1832. [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Ghali, M. J. Koren, J. R. Taylor, E. Brooks-Asplund, K. Fan, W. A. Long, N. Smith, and for the Conivaptan Study Group Efficacy and Safety of Oral Conivaptan: A V1A/V2 Vasopressin Receptor Antagonist, Assessed in a Randomized, Placebo-Controlled Trial in Patients with Euvolemic or Hypervolemic Hyponatremia J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2145 - 2152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. T. Abraham, A. A. Shamshirsaz, K. McFann, R. M. Oren, and R. W. Schrier Aquaretic Effect of Lixivaptan, an Oral, Non-Peptide, Selective V2 Receptor Vasopressin Antagonist, in New York Heart Association Functional Class II and III Chronic Heart Failure Patients J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1615 - 1621. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Goldberg, H. Hammerman, S. Petcherski, M. Nassar, A. Zdorovyak, S. Yalonetsky, M. Kapeliovich, Y. Agmon, R. Beyar, W. Markiewicz, et al. Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction. Arch Intern Med, April 10, 2006; 166(7): 781 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. de Silva, N. P. Nikitin, K. K.A. Witte, A. S. Rigby, K. Goode, S. Bhandari, A. L. Clark, and J. G.F. Cleland Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis Eur. Heart J., March 1, 2006; 27(5): 569 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Lee, J. V. Tu, D. N. Juurlink, D. A. Alter, D. T. Ko, P. C. Austin, A. Chong, T. A. Stukel, D. Levy, and A. Laupacis Risk-Treatment Mismatch in the Pharmacotherapy of Heart Failure JAMA, September 14, 2005; 294(10): 1240 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Heywood, W. Elatre, R. G. Pai, S. Fabbri, and B. Huiskes Simple Clinical Criteria to Determine the Prognosis of Heart Failure Journal of Cardiovascular Pharmacology and Therapeutics, July 1, 2005; 10(3): 173 - 180. [Abstract] [PDF]
|
|
|
|
|
|
L. W. Stevenson, A. Nohria, and L. Mielniczuk Torrent or Torment From the Tubules?: Challenge of the Cardiorenal Connections J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2004 - 2007. [Full Text] [PDF]
|
|
|
|
|
|
L. Klein, C. M. O'Connor, J. D. Leimberger, W. Gattis-Stough, I. L. Pina, G. M. Felker, K. F. Adams Jr, R. M. Califf, M. Gheorghiade, and for the OPTIME-CHF Investigators Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure: Results From the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Study Circulation, May 17, 2005; 111(19): 2454 - 2460. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Wu, K. D. Aaronson, S. F. Bolling, F. D. Pagani, K. Welch, and T. M. Koelling Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction J. Am. Coll. Cardiol., February 1, 2005; 45(3): 381 - 387. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Krack, B. M. Richartz, A. Gastmann, K. Greim, U. Lotze, S. D. Anker, and H. R. Figulla Studies on intragastric PCO2 at rest and during exercise as a marker of intestinal perfusion in patients with chronic heart failure Eur J Heart Fail, June 1, 2004; 6(4): 403 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kearney, J. Nolan, A. J. Lee, P. W. Brooksby, R. Prescott, A. M. Shah, A. G. Zaman, D. L. Eckberg, H.S. Lindsay, P. D. Batin, et al. A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilised on angiotensin converting enzyme inhibitors Eur J Heart Fail, August 1, 2003; 5(4): 489 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kittleson, S. Hurwitz, M. R. Shah, A. Nohria, E. Lewis, M. Givertz, J. Fang, J. Jarcho, G. Mudge, and L. W. Stevenson Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2029 - 2035. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M L Bouvy, E R Heerdink, H G M Leufkens, and A W Hoes Predicting mortality in patients with heart failure: a pragmatic approach Heart, June 1, 2003; 89(6): 605 - 609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nohria, S. W. Tsang, J. C. Fang, E. F. Lewis, J. A. Jarcho, G. H. Mudge, and L. W. Stevenson Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1797 - 1804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. T. Bethea, D. D. Yuh, J. V. Conte, and W. A. Baumgartner Heart Transplantation Card. Surg. Adult, January 1, 2003; 2(2003): 1427 - 1460. [Full Text]
|
|
|
|
|
|
M. T. Kearney, K. A. A. Fox, A. J. Lee, R. J. Prescott, A. M. Shah, P. D. Batin, W. Baig, S. Lindsay, T. S. Callahan, W. E. Shell, et al. Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1801 - 1808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Marenzi, G. Lauri, E. Assanelli, M. Grazi, J. Campodonico, G. Famoso, and P. Agostoni Serum to urinary sodium concentration ratio is an estimate of plasma renin activity in congestive heart failure Eur J Heart Fail, October 1, 2002; 4(5): 597 - 603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. McClellan, W. D. Flanders, R. D. Langston, C. Jurkovitz, and R. Presley Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals: A Population-Based Study J. Am. Soc. Nephrol., July 1, 2002; 13(7): 1928 - 1936. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Ward The need for palliative care in the management of heart failure Heart, March 1, 2002; 87(3): 294 - 298. [Full Text] [PDF]
|
|
|
|
|
|
A. Nohria, E. Lewis, and L. W. Stevenson Medical Management of Advanced Heart Failure JAMA, February 6, 2002; 287(5): 628 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Wong and J. G. Verbalis Vasopressin V2 receptor antagonists Cardiovasc Res, August 15, 2001; 51(3): 391 - 402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. R Kalra, S. D Anker, and A. J.S Coats Water and sodium regulation in chronic heart failure: the role of natriuretic peptides and vasopressin Cardiovasc Res, August 15, 2001; 51(3): 495 - 509. [Full Text] [PDF]
|
|
|
|
 |
|
 R. W Schrier, M. A Cadnapaphornchai, and M. Ohara Water retention and aquaporins in heart failure, liver disease and pregnancy J R Soc Med, January 6, 2001; 94(6): 265 - 269. [Full Text] [PDF]
|
|
|
|
|
|
F. X. Kleber, G. Vietzke, K. D. Wernecke, U. Bauer, C. Opitz, R. Wensel, A. Sperfeld, and S. Glaser Impairment of Ventilatory Efficiency in Heart Failure : Prognostic Impact Circulation, June 20, 2000; 101(24): 2803 - 2809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Hall The aspirin-angiotensin-converting enzyme inhibitor tradeoff: to halve and halve not J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1808 - 1812. [Full Text] [PDF]
|
|
|
|
|
|
M R Cowie, D A Wood, A J S Coats, S G Thompson, V Suresh, P A Poole-Wilson, and G C Sutton Survival of patients with a new diagnosis of heart failure: a population based study Heart, May 1, 2000; 83(5): 505 - 510. [Abstract] [Full Text]
|
|
|
|
|
|
K. Pardaens, J. Van Cleemput, J. Vanhaecke, and R. H. Fagard Peak Oxygen Uptake Better Predicts Outcome Than Submaximal Respiratory Data in Heart Transplant Candidates Circulation, March 14, 2000; 101(10): 1152 - 1157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P O Lim, R J MacFadyen, and A D Struthers Is there a role for renin profiling in selecting chronic heart failure patients for ACE inhibitor treatment? Heart, March 1, 2000; 83(3): 257 - 261. [Abstract] [Full Text]
|
|
|
|
|
|
L C Davies, D P Francis, M Piepoli, A C Scott, P Ponikowski, and A J S Coats Chronic heart failure in the elderly: value of cardiopulmonary exercise testing in risk stratification Heart, February 1, 2000; 83(2): 147 - 151. [Abstract] [Full Text]
|
|
|
|
|
|
R. W. Schrier and W. T. Abraham Hormones and Hemodynamics in Heart Failure N. Engl. J. Med., August 19, 1999; 341(8): 577 - 585. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Macdonald, A. M. Keogh, C. L. Aboyoun, M. Lund, R. Amor, and D. J. McCaffrey Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure J. Am. Coll. Cardiol., March 15, 1999; 33(4): 924 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Yamamura, S. Nakamura, S. Itoh, T. Hirano, T. Onogawa, T. Yamashita, Y. Yamada, K. Tsujimae, M. Aoyama, K. Kotosai, et al. OPC-41061, a Highly Potent Human Vasopressin V2-Receptor Antagonist: Pharmacological Profile and Aquaretic Effect by Single and Multiple Oral Dosing in Rats J. Pharmacol. Exp. Ther., December 1, 1998; 287(3): 860 - 867. [Abstract] [Full Text]
|
|
|
|
 |
|
 W. T. Abraham Pharmacologic Management of Chronic Heart Failure: A Review Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1998; 2(3): 168 - 190. [Abstract] [PDF]
|
|
|
|
|
|
A. Tahara, Y. Tomura, K.-I. Wada, T. Kusayama, J. Tsukada, M. Takanashi, T. Yatsu, W. Uchida, and A. Tanaka Pharmacological Profile of YM087, A Novel Potent Nonpeptide Vasopressin V1A and V2 Receptor Antagonist, in Vitro and in Vivo J. Pharmacol. Exp. Ther., July 1, 1997; 282(1): 301 - 308. [Abstract] [Full Text]
|
|
|
|
|
|
K. D. Aaronson, J. S. Schwartz, T.-M. Chen, K.-L. Wong, J. E. Goin, and D. M. Mancini Development and Prospective Validation of a Clinical Index to Predict Survival in Ambulatory Patients Referred for Cardiac Transplant Evaluation Circulation, June 17, 1997; 95(12): 2660 - 2667. [Abstract] [Full Text]
|
|
|
|
|
|
M. H. Chin and L. Goldman Correlates of Major Complications or Death in Patients Admitted to the Hospital With Congestive Heart Failure Arch Intern Med, September 9, 1996; 156(16): 1814 - 1820. [Abstract] [PDF]
|
|
|
|
|
|
C. R. Benedict, B. Shelton, D. E. Johnstone, G. Francis, B. Greenberg, M. Konstam, J. L. Probstfield, and S. Yusuf Prognostic Significance of Plasma Norepinephrine in Patients With Asymptomatic Left Ventricular Dysfunction Circulation, August 15, 1996; 94(4): 690 - 697. [Abstract] [Full Text]
|
|
|
|
 |
|
 L. W. Stevenson Patient Selection for Mechanical Bridging to Transplantation Ann. Thorac. Surg., January 1, 1996; 61(1): 380 - 387. [Abstract] [Full Text]
|
|
|
|
|
|
L. W. Stevenson, G. Couper, B. Natterson, G. Fonarow, M. A. Hamilton, M. Woo, and J. W. Creaser Target Heart Failure Populations for Newer Therapies Circulation, November 1, 1995; 92(9): 174 - 181. [Abstract] [Full Text]
|
|
|
|
|
|
G. W. Dec and V. Fuster Idiopathic Dilated Cardiomyopathy N. Engl. J. Med., December 8, 1994; 331(23): 1564 - 1575. [Full Text]
|
|
|
|
 |
|
 S. V. Abramson, J. F. Burke, J. J. Kelly Jr., J. G. Kitchen III, M. J. Dougherty, D. F. Yih, F. C. McGeehin III, J. W. Shuck, and T. P. Phiambolis Pulmonary Hypertension Predicts Mortality and Morbidity in Patients with Dilated Cardiomyopathy Ann Intern Med, June 1, 1992; 116(11): 888 - 895. [Abstract] [PDF]
|
|
|
|
|
|
J. R. Oster and B. J. Materson Renal and Electrolyte Complications of Congestive Heart Failure and Effects of Therapy With Angiotensin-Converting Enzyme Inhibitors Arch Intern Med, April 1, 1992; 152(4): 704 - 710. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Marangoni, A. Oddone, M. Surian, C. Panciroli, G. Galloni, A. Masa, V. Caizzi, S. Belletti, W. R. Cominesi, and M. Orlandi Effect of High-Dose Furosemide in Refractory Congestive Heart Failure Angiology, October 1, 1990; 41(10): 862 - 868. [Abstract] [PDF]
|
|
|
|
|
|
C. Panciroli, G. Galloni, A. Oddone, E. Marangoni, A. Masa, W. R. Cominesi, V. Caizzi, C. Pezzi, S. Belletti, C. Comalba, et al. Prognostic Value of Hyponatremia in Patients with Severe Chronic Heart Failure Angiology, August 1, 1990; 41(8): 631 - 638. [Abstract] [PDF]
|
|