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European Journal of Heart Failure 2008 10(12):1208-1214; doi:10.1016/j.ejheart.2008.09.011
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© 2008 European Society of Cardiology

Transcardiac increase in norepinephrine and prognosis in patients with chronic heart failure

Takayoshi Tsutamoto*, Keizo Nishiyama, Hiroshi Sakai, Toshinari Tanaka, Masanori Fujii, Takashi Yamamoto, Masayuki Yamaji and Minoru Horie

Cardiovascular and Respiratory Medicine, Shiga University of Medical Science Tsukinowa, Seta, Otsu 520-2192, Japan

* Corresponding author. Tel.: +81 77 548 2213; fax: +81 77 543 5839. E-mail address: tutamoto{at}belle.shiga-med.ac.jp (T. Tsutamoto).


  Abstract

Background: No previous study has compared the transcardiac gradient of norepinephrine (NE) and the prognosis of patients with chronic heart failure (CHF).

Aim: To evaluate the prognostic role of the transcardiac gradient of NE in patients with CHF.

Methods: We measured haemodynamic parameters and plasma levels of NE, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in the aortic root (AO) and coronary sinus (CS) in 356 consecutive patients with CHF.

Results: During a median follow-up of 3.5 years, 40 patients died. Transcardiac gradients of BNP (273±276 vs. 472±433 pg/mL, p<0.0001), NT-proBNP (417±700 vs. 928±1093 pg/mL, p<0.0001) and NE (114±160 vs. 473±992 pg/mL, p<0.0001) were significantly higher in non-survivors than survivors. After adjustment for clinical variables associated with CHF including haemodynamics and neurohumoral factors, the transcardiac gradient of NE (p<0.0001) and plasma log NT-proBNP (p<0.0001) were independent prognostic predictors. Among 67 patients in whom 123I-metaiodobenzylguanidine (MIBG) could be performed, transcardiac increase in NE was correlated with the washout rate (r=0.398, p=0.0009) and was a superior predictor of mortality than MIBG parameters on stepwise multivariable Cox proportional hazards regression analyses.

Conclusion: The transcardiac increase in NE is an independent and useful prognostic predictor for evaluating the prognosis of CHF patients.

Key Words: Sympathetic nervous activity • Norepinephrine • N-terminal pro brain natriuretic peptide • Prognosis • 123I-metaiodobenzylguanidine

Received May 22, 2008; Revised July 30, 2008; Accepted September 22, 2008


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