38 Correlation between Aldosterone Levels and Oedema in a Series of Patients Admitted with Acute Decompensated Heart Failure – a Preliminary Investigation

Abstract

<h3>Introduction</h3> Patients with acutely decompensated chronic heart failure present with variable degrees of fluid retention and peripheral oedema. It is current practice to target oedematous patients with high doses of loop diuretics whilst aldosterone antagonists (MRAs) are generally prescribed at relatively low doses regardless of clinical presentation. Although aldosterone is known to be elevated in patients with heart failure it is not yet established whether aldosterone levels affect clinical presentation. The rationale for this study is to establish the degree of variation in baseline aldosterone and whether there is any relation between aldosterone levels and extent of peripheral oedema. Ultimately this information may be helpful in guiding choice of diuretic therapy and specifically identifying patients who may benefit from MRAs prescribed at higher doses than those used in current clinical practice. <h3>Methods</h3> We enrolled 29 patients admitted to the cardiology ward with a diagnosis of acutely decompensated chronic heart failure (diagnosis confirmed using Framingham criteria). Aldosterone was measured on the first morning after admission. Serum creatinine and BNP were measured simultaneously to control for renal function (eGFR) and overall severity of heart failure. The extent of oedema was assessed using a standard scoring system (levels 1 to 4 with 4 being the most extensive). <h3>Results</h3> All patients had moderate or severe impairment of left ventricular function and were either NHYA class 2 (n = 8) or 3 (n = 21). The mean age was 76 (range: 43–90). Aldosterone levels varied widely (mean: 496; range 60 – 2775 pmol/l) and there was no correlation between aldosterone and BNP (R²=0.02) or between aldosterone and eGFR (R²=0.13). Aldosterone levels were higher in patients with oedema score 3 to 4 than in those with oedema score 1 to 2 (mean: 688 vs 289 pmol/l; p = 0.04 one tailed unpaired t test). See Figure 1. <h3>Conclusion</h3> Aldosterone levels vary widely in patients presenting with acutely decompensated heart failure but appear to be highest in those with gross peripheral oedema. The findings from this preliminary study need to be confirmed in a larger cohort of patients but may have potential implications for guiding diuretic therapy.