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European Heart Journal Advance Access published online on March 10, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi184
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received August 19, 2004
Revised January 20, 2005
Accepted January 27, 2005

Clinical research

Long-term outcome in relation to renal sympathetic activity in patients with chronic heart failure

Magnus Petersson 1*, Peter Friberg 2, Graeme Eisenhofer 3, Gavin Lambert 4, and Bengt Rundqvist 1

1 Department of Cardiology, The Cardiovascular Institute, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
2 Department of Clinical Physiology, The Cardiovascular Institute, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
3 Clinical Neurocardiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
4 Baker Heart Research Institute, Melbourne, Australia

* To whom correspondence should be addressed.
Magnus Petersson, E-mail: magnus.petersson{at}wlab.gu.se


  Abstract

Aims Although cardiac sympathetic activation is associated with adverse outcome in patients with chronic heart failure (CHF), the influence of renal sympathetic activity on outcome is unknown. We assessed the hypothesis that renal noradrenaline (NA) spillover is a predictor of the combined endpoint of all-cause mortality and heart transplantation in CHF.

Methods and results Sixty-one patients with CHF, New York Heart Association (NYHA) I-IV (66% NYHA III-IV), and left ventricular ejection fraction (LVEF) 26±9% (mean ± SD) were studied with cardiac and renal catheterizations at baseline and followed for 5.5 ± 3.7 years (median 5.5 years, range 12 days to 11.6 years). Nineteen deaths and 13 cases of heart transplantation were registered. Only renal NA spillover above median, 1.19 (interquartile range 0.77-1.43) nmol/min, was independently associated with an increased relative risk (RR) of the combined endpoint (RR 3.1, 95% CI 1.2-7.6, P = 0.01) in a model also including total body NA spillover, LVEF, glomerular filtration rate (GFR), renal blood flow, cardiac index, aetiology, and age.

Conclusion Renal noradrenergic activation has a strong negative predictive value on outcome independent of overall sympathetic activity, GFR, and LVEF. These findings suggest that treatment regimens that further reduce renal noradrenergic stimulation could be advantageous by improving survival in patients with CHF.

Keywords: Heart failure; Congestive; Survival analysis; Sympathetic nervous system; Noradrenaline; Renal circulation.
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