Neurohormonal activation in heart failure after acute myocardial infarction treated with beta-receptor antagonists
(2002) In European Journal of Heart Failure 4(1). p.73-82- Abstract
- Background: Few studies have described how neurohormonal activation is influenced by treatment with beta-receptor antagonists in patients with heart failure after acute myocardial infarction. The aims were to describe neurohormonal activity in relation to other variables and to investigate treatment effects of a beta, receptor-antagonist compared to a partial beta, receptor-agonist. Methods: Double-blind, randomized comparison of metoprolol 50-100 mg b.i.d. (n = 74), and xamoterol 100-200 mg b.i.d (n = 67). Catecholamines, neuropeptide Y-like immunoreactivity (NPY-LI), renin activity, and N-terminal pro-atrial natriuretic factor (N-ANF) were measured in venous plasma before discharge and after 3 months. Clinical and echocardiographic... (More)
- Background: Few studies have described how neurohormonal activation is influenced by treatment with beta-receptor antagonists in patients with heart failure after acute myocardial infarction. The aims were to describe neurohormonal activity in relation to other variables and to investigate treatment effects of a beta, receptor-antagonist compared to a partial beta, receptor-agonist. Methods: Double-blind, randomized comparison of metoprolol 50-100 mg b.i.d. (n = 74), and xamoterol 100-200 mg b.i.d (n = 67). Catecholamines, neuropeptide Y-like immunoreactivity (NPY-LI), renin activity, and N-terminal pro-atrial natriuretic factor (N-ANF) were measured in venous plasma before discharge and after 3 months. Clinical and echocardiographic variables were assessed. Results: N-ANF showed the closest correlations to clinical and echo cardiographic measures of heart failure severity, e.g. NYHA functional class, furosemide dose, exercise tolerance, systolic and diastolic function. Plasma norepinephrine, dopamine and renin activity decreased after 3 months on both treatments, in contrast to a small increase in NPY-LI which was greater (by 3.9 pmol/l, 95% CI 1.2-6.6) in the metoprolol group. N-ANF increased on metoprolol, and decreased on xamoterol (difference: 408 pmol/l, 95% CI 209-607). Increase above median of NPY-LI (> 25.2 pmol/l, odds ratio 2.8, P = 0.0050) and N-ANF (> 1043 pmol/l, odds ratio 2.8, P = 0.0055) were related to long term (mean follow-up 6.8 years) cardiovascular mortality. Conclusions: Decreased neurohormonal activity, reflecting both the sympathetic nervous system and the renin-angiotensin system, was found 3 months after an acute myocardial infarction with heart failure treated with beta-receptor antagonists. The small increase in NPY-LI may suggest increased sympathetic activity or reduced clearance from plasma. The observed changes of N-ANF may be explained by changes in cardiac preload, renal function, and differences in beta-receptor mediated inhibition of atrial release of N-ANF. NPY-LI, and N-ANF at discharge were related to long term cardiovascular mortality. (C) 2002 European Society of Cardiology. All rights reserved. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/342927
- author
- Persson, H ; Andreasson, K ; Kahan, T ; Eriksson, SV ; Tidgren, B ; Hjemdahl, P ; Hall, C and Erhardt, Leif RW LU
- organization
- publishing date
- 2002
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- congestive heart failure, myocardial infarction, neurohormonal, activation, atrial natriuretic, beta-adrenergic blocking agents, peptide, cardiac function
- in
- European Journal of Heart Failure
- volume
- 4
- issue
- 1
- pages
- 73 - 82
- publisher
- Elsevier
- external identifiers
-
- pmid:11812667
- wos:000174083000010
- scopus:0036154656
- ISSN
- 1879-0844
- DOI
- 10.1016/S1388-9842(01)00196-9
- language
- English
- LU publication?
- yes
- id
- 6c19801a-8ca0-4be5-bc92-5ec288382978 (old id 342927)
- date added to LUP
- 2016-04-01 12:23:02
- date last changed
- 2022-01-27 02:59:48
@article{6c19801a-8ca0-4be5-bc92-5ec288382978,
abstract = {{Background: Few studies have described how neurohormonal activation is influenced by treatment with beta-receptor antagonists in patients with heart failure after acute myocardial infarction. The aims were to describe neurohormonal activity in relation to other variables and to investigate treatment effects of a beta, receptor-antagonist compared to a partial beta, receptor-agonist. Methods: Double-blind, randomized comparison of metoprolol 50-100 mg b.i.d. (n = 74), and xamoterol 100-200 mg b.i.d (n = 67). Catecholamines, neuropeptide Y-like immunoreactivity (NPY-LI), renin activity, and N-terminal pro-atrial natriuretic factor (N-ANF) were measured in venous plasma before discharge and after 3 months. Clinical and echocardiographic variables were assessed. Results: N-ANF showed the closest correlations to clinical and echo cardiographic measures of heart failure severity, e.g. NYHA functional class, furosemide dose, exercise tolerance, systolic and diastolic function. Plasma norepinephrine, dopamine and renin activity decreased after 3 months on both treatments, in contrast to a small increase in NPY-LI which was greater (by 3.9 pmol/l, 95% CI 1.2-6.6) in the metoprolol group. N-ANF increased on metoprolol, and decreased on xamoterol (difference: 408 pmol/l, 95% CI 209-607). Increase above median of NPY-LI (> 25.2 pmol/l, odds ratio 2.8, P = 0.0050) and N-ANF (> 1043 pmol/l, odds ratio 2.8, P = 0.0055) were related to long term (mean follow-up 6.8 years) cardiovascular mortality. Conclusions: Decreased neurohormonal activity, reflecting both the sympathetic nervous system and the renin-angiotensin system, was found 3 months after an acute myocardial infarction with heart failure treated with beta-receptor antagonists. The small increase in NPY-LI may suggest increased sympathetic activity or reduced clearance from plasma. The observed changes of N-ANF may be explained by changes in cardiac preload, renal function, and differences in beta-receptor mediated inhibition of atrial release of N-ANF. NPY-LI, and N-ANF at discharge were related to long term cardiovascular mortality. (C) 2002 European Society of Cardiology. All rights reserved.}},
author = {{Persson, H and Andreasson, K and Kahan, T and Eriksson, SV and Tidgren, B and Hjemdahl, P and Hall, C and Erhardt, Leif RW}},
issn = {{1879-0844}},
keywords = {{congestive heart failure; myocardial infarction; neurohormonal; activation; atrial natriuretic; beta-adrenergic blocking agents; peptide; cardiac function}},
language = {{eng}},
number = {{1}},
pages = {{73--82}},
publisher = {{Elsevier}},
series = {{European Journal of Heart Failure}},
title = {{Neurohormonal activation in heart failure after acute myocardial infarction treated with beta-receptor antagonists}},
url = {{http://dx.doi.org/10.1016/S1388-9842(01)00196-9}},
doi = {{10.1016/S1388-9842(01)00196-9}},
volume = {{4}},
year = {{2002}},
}