Plasma aldosterone levels during hospitalization are predictive of survival post-myocardial infarction

Palmer, Barry R.; Pilbrow, Anna P.; Frampton, Christopher M.; Yandle, Tim G.; Skelton, Lorraine; Nicholls, M. Gary; Richards, A. Mark

doi:10.1093/eurheartj/ehn383

Cited by 74 publications

(49 citation statements)

References 26 publications

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“…Согласно литературным данным, активное воздей-ствие альдостерона на процессы локального интрава-скулярного воспаления, особенно у пациентов с ИМ, сопровождается прогрессированием на ранних этапах изменений структурно-функциональных параметров сердца [6][7][8][9]. В связи с этим проведено исследование эхокардиографических показателей у больных ИМ, развившемся на фоне сопут ствующей НДСТ и без таковой.…”

Section: результатыunclassified

“…В настоящее время обсуждается патогенетическая роль альдостерона в развитии инфаркта миокарда (ИМ) и постинфарктного ремоделирования сердца [6][7][8][9]. Одной из основных точек приложения дей-ствия альдостерона в данном случае является миокар-диальная соединительная ткань, состояние которой играет важную роль в течении репаративно-восстано-вительных процессов, протекающих в сердечной мышце после развития ИМ.…”

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Aldosterone Levels and Heart Remodeling in Myocardial Infarction Patients With Non-Differentiated Connective Tissue Dysplasia

Мирошниченко¹,

Ушаков²,

Кубышкин³

2016

Russ J Cardiol

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Цель. Оценить динамику уровня альдостерона в сыворотке крови и структурно-функциональных параметров сердца у больных инфарктом миокарда, развив-шемся на фоне недифференцированной дисплазии соединительной ткани. Материал и методы. В исследование было включено 90 пациентов с инфарк-том миокарда с зубцом Q с наличием недифференцированной дисплазии сое-динительной ткани и без таковой. Группа контроля -практически здоровые пациенты без сердечно-сосудистой патологии, группа сравнения -пациенты с недифференцированной дисплазией соединительной ткани без сердечно-сосудистой патологии. Проведено клиническое и фенотипическое обследова-ние, эхокардиографическое исследование сердца, определение уровня альдо-стерона сыворотки крови в динамике течения инфаркта миокарда. Результаты. У больных инфарктом миокарда не зависимо от наличия либо отсутствия недифференцированной дисплазии соединительной ткани в 1-е сутки инфаркта отмечалось повышение уровня альдостерона в сыворотке крови с последующим снижением через 28 дней до уровней контрольной группы и группы сравнения. В группе больных инфарктом миокарда с недиф-ференцированной дисплазией соединительной ткани выявлено более выра-женное увеличение размеров полости левого желудочка, снижение его насос-ной функции в сочетании с тенденцией к менее выраженному увеличению индекса массы миокарда левого желудочка по сравнению с пациентами без соединительнотканной дисплазии. Заключение. Наличие недифференцированной дисплазии соединительной ткани не оказывает влияния на уровни альдостерона крови и их динамику при инфаркте миокарда, но в тоже время ассоциируется с более неблагоприятным вариантом постинфарктного ремоделирования сердца в виде дилатации левого желудочка и снижения его сократительной функции. Aim. To assess the dynamics of aldosterone in blood serum and structurefunctional parameters of the heart in myocardial infarction patients, developed on the background of non-differentiated connective tissue dysplasia. Material and methods. Totally, 90 patients included with Q-myocardial infarction with non-differentiated connective tissue dysplasia and without it. The controls were almost healthy persons without cardiovascular pathology, comparison grouppatients with connective tissue dysplasia but not having cardiovascular pathology. Clinical and phenotypic assessment was done, echocardiography, aldosterone levels measurement in serum at dynamics of the infarction course. Results. All patients, independent of existence of connective tissue dysplasia, showed aldosterone elevation at 1st day of infarction with further decrease to the level of controls or comparison in 28 days. In the group of infarction patients with non-differentiated connective tissue dysplasia there was significant enlargement of the left ventricle size, reduced pumping function with tendency to less prominent myocardial mass index increase comparing with those not having dysplasia. Conclusion.Presence of non-differentiated connective tissue dysplasia does not influence aldosterone levels and their dynamics in myocardial...

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Section: результатыunclassified

unclassified

Aldosterone Levels and Heart Remodeling in Myocardial Infarction Patients With Non-Differentiated Connective Tissue Dysplasia

Мирошниченко¹,

Ушаков²,

Кубышкин³

2016

Russ J Cardiol

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“…In patients with preserved left ventricular function but increased natriuretic peptides, serum concentrations of aldosterone measured 3-10 days after the index event were higher than those observed in other post-MI cohorts (1)(2)(3) or patients with stable coronary artery disease undergoing elective angiography (23 ). Baseline values among patients in AVANT GARDE-TIMI 43 were approximately 2-fold higher than those measured 1-3 days post-MI in a mix of patients with and without heart failure and LVSD in the OPERA registry (Observatoire sur la Prise en Charge Hospitalière, l'Evolution à un An et les Caractéristiques de Patient Présentant un Infarctus du Myocarde avec ou sans Onde Q) (3 ).…”

Section: Findings In Avant Garde-timi 43mentioning

confidence: 78%

Inhibition of the Renin-Angiotensin System Reduces the Rise in Serum Aldosterone in Acute Coronary Syndrome Patients with Preserved Left Ventricular Function: Observations from the AVANT GARDE-TIMI 43 Trial

et al. 2013

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BACKGROUND: Acute coronary syndrome (ACS) activates neurohormonal pathways, including elevations in circulating aldosterone, with deleterious cardiovascular effects. We aimed to determine if early, more complete renin-angiotensin-aldosterone system inhibition (RAASI) in post-ACS patients without ventricular dysfunction or heart failure would result in a graded reduction in aldosterone concentrations.

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“…First, the current analysis cohort is much larger and reflects a globally diverse population with broad application of evidence‐based treatments. Second, in this analysis aldosterone was measured in the subacute period after ACS, whereas in prior studies aldosterone had been measured at the time of presentation with ACS 13, 14, 24, 25. In the immediate period after ACS, left ventricular function, hemodynamics, manifestations of heart failure, and aldosterone levels themselves are in flux 12, 26.…”

Section: Discussionmentioning

confidence: 99%

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Pitts

Gunzburger

Ballantyne

et al. 2017

JAHA

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BackgroundAldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk.Methods and ResultsTo address this question, we examined data from the dal‐OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF <40%), III, or IV HF were excluded. Aldosterone was measured at randomization in 4073 patients. The primary outcome was a composite of coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow‐up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78‐1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96‐1.99, P=0.08) in Cox regression models adjusted for covariates.ConclusionsIn patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515.

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Plasma aldosterone levels during hospitalization are predictive of survival post-myocardial infarction

Abstract: Plasma aldosterone levels post-MI are independent predictors of survival and hospitalization for heart failure over a 5-year-follow-up period.

Cited by 74 publications

References 26 publications

Aldosterone Levels and Heart Remodeling in Myocardial Infarction Patients With Non-Differentiated Connective Tissue Dysplasia

Aldosterone Levels and Heart Remodeling in Myocardial Infarction Patients With Non-Differentiated Connective Tissue Dysplasia

Inhibition of the Renin-Angiotensin System Reduces the Rise in Serum Aldosterone in Acute Coronary Syndrome Patients with Preserved Left Ventricular Function: Observations from the AVANT GARDE-TIMI 43 Trial

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

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