Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD).

TLDR

Neuroendocrine activation is established in congestive heart failure, but it is unclear whether it precedes or follows overt symptoms. The SOLVD multicenter study compared baseline plasma norepinephrine, renin activity, atrial natriuretic factor, and vasopressin among 56 controls, 151 patients with left‑ventricular dysfunction without heart failure, and 81 patients with overt heart failure before randomization. Patients with left‑ventricular dysfunction already exhibit significantly elevated neuroendocrine markers compared to controls, with the highest levels in overt heart failure; renin activity remains normal in untreated dysfunction but rises with diuretic therapy, indicating progressive activation as heart failure develops.

Abstract

Neuroendocrine activation is known to occur in patients with congestive heart failure, but there is uncertainty as to whether this occurs before or after the presence of overt symptoms. In the Studies of Left Ventricular Dysfunction (SOLVD), a multicenter study of patients with ejection fractions of 35% or less, we compared baseline plasma norepinephrine, plasma renin activity, plasma atrial natriuretic factor, and plasma arginine vasopressin in 56 control subjects, 151 patients with left ventricular dysfunction (no overt heart failure), and 81 patients with overt heart failure before randomization. Median values for plasma norepinephrine (p = 0.0001), plasma atrial natriuretic factor (p less than 0.0001), plasma arginine vasopressin (p = 0.006), and plasma renin activity (p = 0.03) were significantly higher in patients with left ventricular dysfunction than in normal control subjects. Neuroendocrine values were highest in patients with overt heart failure. Plasma renin activity was normal in patients with left ventricular dysfunction without heart failure who were not receiving diuretics and was significantly increased (p less than 0.05) in patients on diuretic therapy. We conclude that neuroendocrine activation occurs in patients with left ventricular dysfunction and no heart failure. Neuroendocrine activation is further increased as overt heart failure ensues and diuretics are added to therapy.