PLASMA NOREPINEPHRINE AS A GUIDE TO PROGNOSIS IN PATIENTS WITH CHRONIC CONGESTIVE HEART-FAILURE
PLASMA NOREPINEPHRINE AS A GUIDE TO PROGNOSIS IN PATIENTS WITH CHRONIC CONGESTIVE HEART-FAILURE
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DOI：
10.1056/nejm198409273111303
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发表时间：
1984-01-01
影响因子：
158.5
通讯作者：
RECTOR, T
中科院分区：
文献类型：
--
作者：
COHN, JN;LEVINE, TB;RECTOR, T
对106例中重度充血性心力衰竭患者（83例男性和23例女性）在仰卧位静息时进行了血流动力学、血浆去甲肾上腺素和血浆肾素活性测定。随访1 ~ 62个月，60例患者死亡（57%）; 47%的死亡是突然的，45%与进行性心力衰竭有关。在统计学上与死亡风险无关的因素有：病因（60例冠心病，46例心肌病）、年龄（平均54.8岁）、心脏指数（平均2.11 l/min/m2体表面积）、肺楔压（平均24.5 mm Hg）和平均动脉压（平均83.2 mm Hg）。对5个显著单变量进行多变量分析，（平均84.4次/分），血浆肾素活性（平均15.4 ng/ml/h），血浆去甲肾上腺素（平均值，700 pg/ml），血清钠（平均135.7 mmol/l）和每搏作功指数（平均21.0 g/m2）发现只有血浆去甲肾上腺素与随后的死亡风险独立相关（P = 0.002）。死于进行性心力衰竭的患者的去甲肾上腺素水平也高于突然死亡的患者。显示血浆去甲肾上腺素浓度的单个静息静脉血样本可能比其他通常测量的心脏性能指标提供更好的预后指导。
Hemodynamics, plasma norepinephrine, and plasma renin activity were measured at supine rest in 106 patients (83 men and 23 women) with moderate to severe congestive heart failure. During follow-up lasting 1 to 62 mo., 60 patients died (57%); 47% of the deaths were sudden, and 45% were related to progressive heart failure. Statistically unrelated to the risk of mortality were cause of disease (60 patients had coronary disease, and 46 had cardiomyopathy), age (mean, 54.8 yr), cardiac index (mean, 2.11 l/min per square meter of body-surface area), pulmonary wedge pressure (mean, 24.5 mm Hg), and mean arterial pressure (mean, 83.2 mm Hg). A multivariate analysis of the 5 significant univariate prognosticators, heart rate (mean, 84.4 beats/min), plasma renin activity (mean, 15.4 ng/ml per h), plasma norepinephrine (mean, 700 pg/ml), serum Na (mean, 135.7 mmol/l), and stroke-work index (mean, 21.0 g/m) found only plasma norepinephrine to be independently (P = 0.002) related to the subsequent risk of mortality. Norepinephrine was also higher in patients who died from progressive heart failure than in those who died suddenly. A single resting venous blood sample showing the plasma norepinephrine concentration may provide a better guide to prognosis than other commonly measured indexes of cardiac performance.