Background: Renin-angiotensin-aldosterone system (RAAS) activation in heart failure with reduced ejection fraction (HFREF) is detrimental through promotion of ventricular remodeling and salt and water retention. Aims: The aims of this article are to describe RAAS activity in distinct HFREF populations and to assess its prognostic impact. Methods: Venous blood samples were prospectively obtained in 76 healthy volunteers, 72 patients hospitalized for acute decompensated HFREF, and 78 ambulatory chronic HFREF patients without clinical signs of congestion. Sequential measurements were performed in patients with acute decompensated HFREF. Results: Plasma renin activity (PRA) was significantly higher in ambulatory chronic HFREF (7.6 ng/ml/h (2.2; 18.1)) compared to patients with acute decompensated HFREF (1.5 ng/ml/h (0.8; 5.7)) or healthy volunteers (1.4 ng/ml/h (0.6; 2.3)) (all p < 0.05). PRA was significantly associated with arterial blood pressure and renin-angiotensin system blocker dose. A progressive rise in PRA (+4 ng/ml/h (0.4; 10.9); p < 0.001) was observed in acute decompensated HFREF patients after three consecutive days of decongestive treatment. Only in acute HFREF were PRA levels associated with increased cardiovascular mortality or HF readmissions (p = 0.035). Conclusion: PRA is significantly elevated in ambulatory chronic HFREF patients but is not associated with worse outcome. In contrast, in acute HFREF patients, PRA is associated with cardiovascular mortality or HF readmissions.
|Original language||English (US)|
|Journal||JRAAS - Journal of the Renin-Angiotensin-Aldosterone System|
|State||Published - Jul 2017|
Bibliographical noteFunding Information:
P. N., F.H.V., P.M. and W.M. are researchers for the Limburg Clinical Research Program (LCRP) UHasselt–ZOL–Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. F.H.V. and P.B.B. are supported by a PhD fellowship of the Research Foundation–Flanders (FWO). P.N. and M.D. are supported by a research grant provided by Vision4Life-Sciences.
- Renin-angiotensin system
- Systolic heart failure