PROGNOSTIC IMPORTANCE OF SERUM SODIUM CONCENTRATION AND ITS MODIFICATION BY CONVERTING-ENZYME INHIBITION IN PATIENTS WITH SEVERE CHRONIC HEART-FAILURE
PROGNOSTIC IMPORTANCE OF SERUM SODIUM CONCENTRATION AND ITS MODIFICATION BY CONVERTING-ENZYME INHIBITION IN PATIENTS WITH SEVERE CHRONIC HEART-FAILURE
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DOI：
10.1161/01.cir.73.2.257
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发表时间：
1986-02-01
期刊：
影响因子：
37.8
通讯作者：
PACKER, M
中科院分区：
文献类型：
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作者：
LEE, WH;PACKER, M
虽然过去的报告已经确定了各种严重慢性心力衰竭患者的预后因素，以前的研究没有评估预后变量和药物治疗的相互作用。我们分析了203例连续严重心力衰竭患者的30个临床、血流动力学和生化变量与生存率的相关性;所有变量在开始使用各种血管扩张药物治疗前进行评估，所有患者随后随访6至94个月。通过回归分析，治疗前血清钠浓度是心血管死亡率最有力的预测因子，低钠血症患者的中位生存期明显短于血清钠浓度正常的患者（164 vs 373天，p = 0.006）。低钠血症患者的不良预后似乎与我们在这些个体中观察到的血浆肾素活性显著升高有关（10.0 ± 0.01）。2.0 ng/ml/hr），因为低钠血症患者接受血管紧张素转换酶抑制剂治疗时的表现明显优于接受不干扰血管紧张素II生物合成的血管扩张药物治疗（中位生存期232 vs 108天，p = 0.003）。相反，对于血清钠浓度正常、血浆肾素活性低（1.9 ± 0.01）的患者，转化酶抑制剂对患者的生存没有选择性益处。0.3 ng/ml/hr）。血清钠浓度、药物治疗和长期结局之间的相互作用表明，肾素-血管紧张素系统可能对某些慢性心力衰竭患者的生存产生有害影响，这可以通过抑制转化酶来拮抗，并为血管紧张素II在心力衰竭实验制剂中假定的类似预后作用提供了临床对应物。
Although past reports have identified a variety of prognostic factors in patients with severe chronic heart failure, previous studies have not evaluated the interaction of prognostic variables and drug treatment. We analyzed the association of 30 clinical, hemodynamic, and biochemical variables with survival in 203 consecutive patients with severe heart failure; all variables were assessed just before initiation of treatment with a variety of vasodilator drugs, and all patients were subsequently followed for 6 to 94 months. By regression analysis, pretreatment serum sodium concentration was the most powerful predictor of cardiovascular mortality, with hyponatremic patients having a substantially shorter median survival than did patients with a normal serum sodium concentration (164 vs 373 days, p = .006). The unfavorable prognosis for hyponatremic patients appeared to be related to the marked elevation of plasma renin activity that we noted in these individuals (10.0 .+-. 2.0 ng/ml/hr), since hyponatremic patients fared significantly better when treated with angiotensin converting-enzyme inhibitors than when treated with vasodilator drugs that did not interfere with angiotensin II biosynthesis (median survival 232 vs 108 days, p = .003). In contrast, there was no selective benefit of converting-enzyme inhibition on the survival of patients with a normal serum sodium concentration, in whom plasma renin activity was low (1.9 .+-. 0.3 ng/ml/hr). This interaction between serum sodium concentration, drug treatment, and long-term outcome suggests that the renin-angiotensin system may exert a deleterious effect on the survival of some patients with chronic heart failure, which can be antagonized by converting enzyme inhibition, and provides a clinical counterpart for the similar prognostic role that has been postulated for angiotensin II in experimental preparations of heart failure.