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Neurohormonal activation in heart failure after acute myocardial infarction treated with beta-receptor antagonists

Persson, H; Andreasson, K; Kahan, T; Eriksson, SV; Tidgren, B; Hjemdahl, P; Hall, C and Erhardt, Leif RW LU (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)
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author
organization
publishing date
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
2007-11-08 13:19:39
date last changed
2017-01-01 05:05:46
@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},
  keyword      = {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},
  volume       = {4},
  year         = {2002},
}