082 - Plasma Renin Activity in Distinct Patient Populations with Heart Failure and Reduced Ejection Fraction

Abstract

Background: Renin-angiotensin-aldosterone system (RAAS) activation in heart failure with reduced ejection fraction (HFREF) is detrimental through cardiac remodeling and water/salt retention. Aims: This study aims to describe RAAS activity in distinct HFREF populations—acute decompensation, chronic HFREF and HFREF with normalized ejection fraction after cardiac resynchronization therapy (CRT)—and to assess its prognostic impact. Methods and Results: In 72 acute decompensated HFREF patients (ADHF), 78 chronic HFREF patients without clinical signs of congestion and 53 patients with HF with normalized ejection fraction (HFNEF), venous blood samples and hemodynamic parameters were obtained. Subjects were prospectively followed up to 30 months. Plasma renin activity (PRA) is significantly lower in ADHF (1.5 ng/ml/h [0.8;5.7]) compared to stable HFREF (7.6 ng/ml/h [2.2;18.1] and HFNEF patients (3.9 ng/ml/h [1.0;13.0]) (all P < .05) (Fig. 1). PRA was significantly associated with arterial blood pressure, renin-angiotensin system blocker dose, beta-blocker dose, and mineralocorticoid receptor antagonist use (all P < .05) but not with age, left ventricular ejection fraction, heart rate, loop diuretic dose, creatinine or NT-pro BNP (all P > .05). High PRA levels are associated with increased cardiovascular mortality or HF admission in acute ADHF, but not in stable HFREF or HFNEF (Fig. 2). Conclusion: PRA is significantly elevated in ambulatory chronic HFREF patients, even when ejection fraction has normalized after CRT which is associated with blood pressure and medication use. Yet, in contrast to ADHF where PRA levels predict cardiovascular mortality and rehospitalizations, PRA levels are not associated with outcome in chronic HFREF and HFNEF.View Large Image Figure ViewerDownload Hi-res image Download (PPT)