Cardiac risk stratification in patients with congestive heart failure: a catecholamines-beta-adrenoceptor-cAMP pathway.
- Author:
Ying-Xin PENG
1
;
Jiang SHAN
;
Su-jun ZHANG
;
Chun-li RONG
;
Jun-ping LI
;
Na WANG
;
Hao XUE
;
Shi-ling ZHENG
;
Min WU
Author Information
- Publication Type:Journal Article
- MeSH: Aged; Catecholamines; blood; Cyclic AMP; blood; Death, Sudden, Cardiac; Epinephrine; blood; Female; Heart Failure; blood; mortality; Humans; Lymphocytes; chemistry; Male; Middle Aged; Norepinephrine; blood; Receptors, Adrenergic, beta; blood
- From: Chinese Medical Sciences Journal 2005;20(2):93-98
- CountryChina
- Language:English
-
Abstract:
OBJECTIVETo investigate the stratification risk of catecholamines-beta-adrenoceptor (beta-AR)-cAMP pathway for cardiogenic death events in patients with congestive heart failure (CHF).
METHODSA total of 83 identified CHF patients with a baseline and follow-up plasma levels of norepinephrine (NE) and epinephrine (E), lymphocytes beta-AR density (Bmax), and intralymphocyte cAMP content in peripheral blood were followed up. Major cardiogenic death events were registered.
RESULTSThe period between the initial entry and the last follow-up measurement were 51 +/- 16 months, the total duration of clinical follow-up after the last measurement were 14 +/- 8 months. During follow-up, 39 patients died of cardiogenic (sudden death 17 patients, worsening heart failure 22 patients). Persistence of high NE, E, and cAMP from baseline to follow-up were confirmed as risk predicting factors of cardiovascular events. Persistence NE above 4.0 nmol/L, E above 3.5 nmol/L, and the intralymphocyte cAMP content above 3.5 pmd x mg(-1) x pro(-1) from baseline to follow-up were significant adverse prognostic predictors. The major cardiogenic death events rates per 100 patients-years were 1.33 and 4.82 in patients with NE below and above 4.0 nmol/L (HR: 2.91; 95% CI: 1.08-7.33; P = 0.015); were 1.42 and 4.36 in the patients with E levels below and above 3.5 nmol/L (HR: 2.64; 95% CI: 1.02-6.41; P = 0.019); were 1.81 and 4.67 in the patients with the intralymphocyte cAMP content below and above 3.5 pmd x mg(-1) x pro(-1) (HR: 2.79; 95% CI: 1.04-6.83; P = 0.017), but difference was not significant between the beta-AR density below and above median.
CONCLUSIONSPersistent increase in circulating catecholamines and intralymphocyte cAMP content may increase the long-term mortality in CHF patients.