Erne Paul, Müller Andrea, Rossi Gian Paolo, Seifert Burkhardt, Stehlin Fabrice, Redondo Maurice, Bauer Peter T, Kobza Richard, Resink Therese J, Radovanovic Dragana
Laboratory of Signal Transduction, Department of Biomedicine, University Hospital Basel, Hebelstrasse, Basel Department of Cardiology, Luzerner Kantonsspital, Spitalstrasse, Luzern Clinica dell'Ipertensione Arteriosa, Department of Medicine, University Hospital of Padua, Padua, Italy Division of Biostatistics, University of Zurich, EBPI, Hirschengraben, Zürich Institute Viollier, Hagmattstrasse, Allschwil, Switzerland Inovise Medical, Inc., Creekside Corporate Park, Nimbus Ave D, Beaverton, OR AMIS Plus Data Center, University of Zurich, EBPI, Hirschengraben, Zurich, Switzerland.
Medicine (Baltimore). 2017 Jun;96(25):e7282. doi: 10.1097/MD.0000000000007282.
Little is known regarding alterations of the renin-angiotensin system in patients referred for cardiac catheterization. Here, we measured plasma levels of active renin and aldosterone in patients referred for cardiac catheterization in order to determine the prevalence of elevated renin, aldosterone, and the aldosterone-renin ratio.A chemiluminescence assay was used to measure plasma aldosterone concentration (PAC) and active renin levels in 833 consecutive patients, after an overnight fasting and without any medication for least 12 hours. We evaluated associations of the hormonal elevations in relation to hypertension, atrial fibrillation (AF), hypertensive cardiomyopathy, coronary artery disease (CAD), valvular disease, impaired left ventricular ejection fraction (LVEF < 35%), and pulmonary hypertension (arterial pulmonary mean pressure >25 mm Hg).Hyperaldosteronism occurred in around one-third of all examined patients, without significant differences between patients with or without the named cardiac diseases. In a comparison between patients with or without any given cardiac disease condition, renin was significantly elevated in patients with either hypertension (36.4% vs 15.9%), CAD (33.9% vs 22.1%), or impaired LVEF (47.3% vs 24.8%). The angiotensin-renin ratio was elevated in AF patients and in patients with hypertensive cardiomyopathy. Patients with AF and coexisting hypertension had elevated renin more frequently than AF patients without coexisting hypertension (35.3% vs 16.5%; P = .005). Patients with persistent/permanent AF more frequently had elevated renin than patients with paroxysmal AF (34.1% vs 15.8%; P = .007).This prospective study of consecutive cardiac disease patients referred for cardiac catheterization has revealed distinct cardiac disease condition-associated differences in the frequencies of elevations in plasma renin, PAC, and the aldosterone-renin ratio.
对于因心脏导管插入术而接受检查的患者，肾素-血管紧张素系统的改变情况鲜为人知。在此，我们测定了因心脏导管插入术而接受检查的患者的血浆活性肾素和醛固酮水平，以确定肾素、醛固酮升高以及醛固酮-肾素比值升高的患病率。采用化学发光法测定了833例连续患者过夜禁食且至少12小时未服用任何药物后的血浆醛固酮浓度（PAC）和活性肾素水平。我们评估了激素升高与高血压、心房颤动（AF）、高血压性心肌病、冠状动脉疾病（CAD）、瓣膜病、左心室射血分数受损（LVEF＜35%）和肺动脉高压（动脉平均肺动脉压＞25 mmHg）之间的关联。醛固酮增多症发生在所有接受检查患者的三分之一左右，患有或未患有上述心脏病的患者之间无显著差异。在有或无任何特定心脏病情况的患者之间进行比较时，高血压患者（36.4%对15.9%）、CAD患者（33.9%对22.1%）或LVEF受损患者（47.3%对24.8%）的肾素水平显著升高。AF患者和高血压性心肌病患者的血管紧张素-肾素比值升高。合并高血压的AF患者比未合并高血压的AF患者更频繁地出现肾素升高（35.3%对16.5%；P = 0.005）。持续性/永久性AF患者比阵发性AF患者更频繁地出现肾素升高（34.1%对15.8%；P = 0.007）。这项对因心脏导管插入术而接受检查的连续心脏病患者的前瞻性研究揭示了血浆肾素、PAC和醛固酮-肾素比值升高频率与不同心脏病情况相关的差异。
