Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Am Heart J. 2011 Sep;162(3):487-93. doi: 10.1016/j.ahj.2011.06.001. Epub 2011 Jul 26.
The renin-angiotensin-aldosterone system (RAAS) plays a key role in the progression of heart failure (HF) and concomitant kidney dysfunction. Despite the use of RAAS blockade, sustained activation of RAAS has been suggested to link with adverse outcome. We aimed to investigate the prognostic value of active plasma renin concentration (APRC) and prorenin in patients with HF treated with RAAS-blocking agents and its relationship with kidney function parameters.
One hundred clinically stable patients with HF, treated with RAAS-blocking agents, were studied. Renal function parameters including effective renal plasma flow and glomerular filtration rate were measured invasively. The combined end point consisted of all-cause mortality, heart transplantation, and admission to hospital for HF.
Mean age was 58 ± 12 years, and 76% were men. Mean left ventricular ejection fraction was 28 ± 9, and median APRC levels were 24.3 ng/mL per hour. Active plasma renin concentration was most strongly associated with mean arterial pressure (r = 0.60, P < .001). In multivariate linear regression analysis, age, mean arterial pressure, angiotensin II concentration, and use of aldosterone antagonists were significantly related with APRC (adjusted R(2) = 0.53). Patients in the highest quartile of APRC had a worse prognosis. In multivariate analysis, APRC remained associated with worse prognosis: HR 2.87 (95% CI 1.14-7.20), P = .025. Prorenin did not show prognostic value. The prognostic value of APRC was strongest in patients with decreased kidney function.
Our data indicate that APRC is a strong prognostic factor in patients with HF in the presence of RAAS inhibition, especially in patients with kidney dysfunction.
肾素-血管紧张素-醛固酮系统（RAAS）在心力衰竭（HF）的进展和伴随的肾功能障碍中起着关键作用。尽管使用了 RAAS 阻断剂，但 RAAS 的持续激活被认为与不良结局有关。我们旨在研究在接受 RAAS 阻断剂治疗的 HF 患者中，活性血浆肾素浓度（APRC）和前肾素的预后价值及其与肾功能参数的关系。
研究了 100 名接受 RAAS 阻断剂治疗的临床稳定的 HF 患者。测量了包括有效肾血浆流量和肾小球滤过率在内的肾功能参数。复合终点包括全因死亡率、心脏移植和因 HF 住院。
平均年龄为 58 ± 12 岁，76%为男性。平均左心室射血分数为 28 ± 9，中位数 APRC 水平为 24.3ng/ml/小时。活性血浆肾素浓度与平均动脉压相关性最强（r = 0.60，P <.001）。多元线性回归分析显示，年龄、平均动脉压、血管紧张素 II 浓度和醛固酮拮抗剂的使用与 APRC 显著相关（调整 R（2）= 0.53）。APRC 最高四分位数的患者预后较差。在多变量分析中，APRC 与预后不良仍相关：HR 2.87（95%CI 1.14-7.20），P =.025。前肾素没有显示预后价值。APRC 的预后价值在肾功能下降的患者中最强。
我们的数据表明，在存在 RAAS 抑制的情况下，APRC 是 HF 患者的一个强有力的预后因素，尤其是在肾功能障碍的患者中。
