Neuroendocrine activity in untreated heart failure.

Abstract

Neuroendocrine activity was studied in 60 consecutive untreated patients with dyspnoea and a clinical suspicion of heart failure. On the basis of the socalled Boston clinical criteria the diagnosis of heart failure was regarded as unlikely in 26 patients, possible in 15 patients, and definite in 19 patients. These groups were studied before any drug treatment was started and were compared with a control group of 69 healthy individuals. Plasma atrial natriuretic peptide concentration was clearly raised in patients with definite heart failure and slightly raised in patients with possible heart failure.Plasma adrenaline concentration was somewhat raised in patients with definite or possible heart failure, whereas plasma noradrenaline concentration was raised only in patients with definite heart failure. Plasma renin activity was not increased in any of the patient groups and plasma aldosterone concentration was slightly increased only in patients with definite heart failure. In the total patient series there were significant correlations between plasma atrial natriuretic peptide concentration and markers of the severity of left ventricular dysfunction.There was some evidence of neuroendocrine activation in untreated heart failure: plasma concentrations of atrial natriuretic peptide and catecholamines were increased but the renin-angiotensinaldosterone system showed little or no activation. Most studies of the hormonal changes in heart failure have included patients treated with diuretics; there is little information on the activation of the neuroendocrine system in untreated heart failure,9-2 especially on concentrations of atrial natriuretic peptide. We studied neuroendocrine activation in patients in whom the diagnosis of heart failure was suspected for the first time and in whom treatment for the condition had not been started. We used the Boston diagnostic criteria"3 to confirm the clinical diagnosis of heart failure. Patients and methods PATIENTSWe studied 88 patients (37 men and 51 women) with a clinical suspicion of previously unrecognised heart failure and 82 controls (36 men and 46 women), all aged 45-74 years.Patients were identified by 32 primary health care physicians working in community health centres in a defined area in eastern Finland. These physicians had agreed to refer to the university clinic all patients who had presented with symptoms or signs suggestive of heart failure and in whom this condition had not been previously diagnosed. Patients with acute pulmonary oedema complicating myocardial infarction were not included. Those 24 patients who had severe symptoms were referred immediately and studied on the day of referral, whereas the remaining 64 patients with milder symptoms were examined within two weeks of their visit to the primary health care centre. A detailed description of the patient series has been published elsewhere.'4

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