Benedict C R, Johnstone D E, Weiner D H, Bourassa M G, Bittner V, Kay R, Kirlin P, Greenberg B, Kohn R M, Nicklas J M
Division of Cardiology, University of Texas Medical School, Houston 77030.
J Am Coll Cardiol. 1994 May;23(6):1410-20. doi: 10.1016/0735-1097(94)90385-9.
This study examined the relation between neurohumoral activation and severity of left ventricular dysfunction and congestive heart failure in a broad group of patients with depressed left ventricular function who were not recruited on the basis of eligibility for a therapeutic trial.
Previous studies have established the presence of neurohumoral activation in patients with severe congestive heart failure. It is not known whether the activation of these neurohumoral mechanisms is related to an impairment in left ventricular function.
From the 6,273 patients recruited into the Studies of Left Ventricular Dysfunction Registry (SOLVD), a subgroup of 859 patients were randomly selected, and their plasma norepinephrine, plasma renin activity, arginine vasopressin and atrial natriuretic peptide levels were correlated with clinical findings, New York Heart Association functional class, left ventricular ejection fraction and drug use.
There was a weak but significant correlation between ejection fraction and an increase in plasma norepinephrine (rho = -0.18, p < 0.0001), plasma renin activity (rho = -0.24, p < 0.0001) and arginine vasopressin (rho = -0.12, p < 0.003). The only exception was atrial natriuretic peptide, which showed the best correlation to ejection fraction (rho = -0.37, p < 0.0001). Deterioration in functional class was associated more with increases in atrial natriuretic peptide (p = 0.0003) and plasma renin activity (p = 0.0003) and less with an increase in plasma norepinephrine. Of the clinical variables, elevated jugular venous pressure and third heart sound (S3) gallop were significantly associated with increased levels of plasma norepinephrine, plasma renin activity and atrial natriuretic peptide. We then compared the relation of neurohormones with clinical signs, functional status, ejection fraction and drug therapy and controlled for mutual interactive effects. After adjustment, a decrease in ejection fraction was still significantly related to an increase in plasma norepinephrine, plasma renin activity and atrial natriuretic peptide. In contrast, only a difference between functional classes I and III/IV was associated with an increase in plasma renin activity and atrial natriuretic peptide levels.
Neurohumoral activation in patients with heart failure is related to severity of left ventricular functional depression, and this relation is independent of functional class or concomitant drug therapy.
本研究在一组左心室功能降低且并非基于治疗试验入选标准招募的广泛患者群体中，探讨神经体液激活与左心室功能障碍及充血性心力衰竭严重程度之间的关系。
既往研究已证实重度充血性心力衰竭患者存在神经体液激活。尚不清楚这些神经体液机制的激活是否与左心室功能损害有关。
从纳入左心室功能障碍研究注册库（SOLVD）的6273例患者中，随机选取859例患者亚组，将其血浆去甲肾上腺素、血浆肾素活性、精氨酸加压素和心房利钠肽水平与临床检查结果、纽约心脏协会心功能分级、左心室射血分数及药物使用情况进行相关性分析。
射血分数与血浆去甲肾上腺素升高（rho = -0.18，p < 0.0001）、血浆肾素活性升高（rho = -0.24，p < 0.0001）及精氨酸加压素升高（rho = -0.12，p < 0.003）之间存在微弱但显著的相关性。唯一例外的是心房利钠肽，其与射血分数的相关性最佳（rho = -0.37，p < 0.0001）。心功能分级恶化与心房利钠肽升高（p = 0.0003）及血浆肾素活性升高（p = 0.0003）的相关性更强，而与血浆去甲肾上腺素升高的相关性较弱。在临床变量中，颈静脉压升高和第三心音奔马律与血浆去甲肾上腺素、血浆肾素活性及心房利钠肽水平升高显著相关。然后我们比较了神经激素与临床体征、功能状态、射血分数及药物治疗之间的关系，并控制了相互作用效应。调整后，射血分数降低仍与血浆去甲肾上腺素、血浆肾素活性及心房利钠肽升高显著相关。相比之下，仅心功能I级与III/IV级之间的差异与血浆肾素活性及心房利钠肽水平升高有关。
心力衰竭患者的神经体液激活与左心室功能降低的严重程度相关，且这种关系独立于心功能分级或同时进行的药物治疗。
