Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure.

Abstract:

:Although past reports have identified a variety of prognostic factors in patients with severe chronic heart failure, previous studies have not evaluated the interaction of prognostic variables and drug treatment. We analyzed the association of 30 clinical, hemodynamic, and biochemical variables with survival in 203 consecutive patients with severe heart failure; all variables were assessed just before initiation of treatment with a variety of vasodilator drugs, and all patients were subsequently followed for 6 to 94 months. By regression analysis, pretreatment serum sodium concentration was the most powerful predictor of cardiovascular mortality, with hyponatremic patients having a substantially shorter median survival than did patients with a normal serum sodium concentration (164 vs 373 days, p = .006). The unfavorable prognosis for hyponatremic patients appeared to be related to the marked elevation of plasma renin activity that we noted in these individuals (10.0 +/- 2.0 ng/ml/hr), since hyponatremic patients fared significantly better when treated with angiotensin converting-enzyme inhibitors than when treated with vasodilator drugs that did not interfere with angiotensin II biosynthesis (median survival 232 vs 108 days, p = .003). In contrast, there was no selective benefit of converting-enzyme inhibition on the survival of patients with a normal serum sodium concentration, in whom plasma renin activity was low (1.9 +/- 0.3 ng/ml/hr). This interaction between serum sodium concentration, drug treatment, and long-term outcome suggests that the renin-angiotensin system may exert a deleterious effect on the survival of some patients with chronic heart failure, which can be antagonized by converting enzyme inhibition, and provides a clinical counterpart for the similar prognostic role that has been postulated for angiotensin II in experimental preparations of heart failure.

journal_name

Circulation

journal_title

Circulation

authors

Lee WH,Packer M

doi

10.1161/01.cir.73.2.257

subject

Has Abstract

pub_date

1986-02-01 00:00:00

pages

257-67

issue

2

eissn

0009-7322

issn

1524-4539

journal_volume

73

pub_type

杂志文章
  • Blood flow in sequential vein grafts.

    abstract::In 69 patients undergoing coronary artery bypass grafting for complete coronary revascularization, blood flow was measured in 140 grafts with 243 distal anastomoses (3.52 bypasses/patient). Total blood flow in single grafts and double and triple sequential grafts did not differ significantly, although mean distal flow...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.60.2.33

    authors: McNamara JJ,Bjerke HS,Chung GK,Dang CR

    更新日期:1979-08-01 00:00:00

  • Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction:result of aortic valve replacement in 52 patients.

    abstract:BACKGROUND:The outcome of aortic valve replacement in patients with severe aortic stenosis, low transvalvular gradient, and severe left ventricular dysfunction is not well known. METHODS AND RESULTS:Between 1985 and 1995, 52 patients with left ventricular ejection fraction (EF) < or =35% and aortic stenosis with trans...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.101.16.1940

    authors: Connolly HM,Oh JK,Schaff HV,Roger VL,Osborn SL,Hodge DO,Tajik AJ

    更新日期:2000-04-25 00:00:00

  • The interaction of verapamil and norverapamil with beta-adrenergic receptors.

    abstract::To determine the effect of calcium-channel blockers on beta-adrenergic receptors, we studied the interactions of verapamil, diltiazem, and nifedipine with both human lymphocyte beta 2-adrenergic receptors and rat myocardial beta 1-adrenergic receptors by means of radioligand binding assays. We also determined the func...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.72.3.547

    authors: Feldman RD,Park GD,Lai CY

    更新日期:1985-09-01 00:00:00

  • Evaluating the Impact and Cost-Effectiveness of Statin Use Guidelines for Primary Prevention of Coronary Heart Disease and Stroke.

    abstract:BACKGROUND:Statins are effective in the primary prevention of atherosclerotic cardiovascular disease. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline expands recommended statin use, but its cost-effectiveness has not been compared with other guidelines. METHODS:We used the Cardio...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.117.027067

    authors: Heller DJ,Coxson PG,Penko J,Pletcher MJ,Goldman L,Odden MC,Kazi DS,Bibbins-Domingo K

    更新日期:2017-09-19 00:00:00

  • Public policy on smoking and health: toward a smoke-free generation by the year 2000. A statement of a working group to the Subcommittee on Smoking of the American Heart Association.

    abstract::On May 20, 1984, the Surgeon General challenged the health community to work toward attainment of a smoke-free society by the year 2000. The leadership of the nation's three major voluntary organizations joined numerous associations of health professionals in accepting the challenge. The Subcommittee on Smoking of the...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Warner KE,Ernster VL,Holbrook JH,Lewit EM,Pertschuk M,Steinfeld JL,Whelan EM

    更新日期:1986-02-01 00:00:00

  • Transient intermittent lymphocyte activation is responsible for the instability of angina.

    abstract:BACKGROUND:Blood clotting activation is an important component of the inflammatory response; the outbursts of unstable angina are usually associated with increased thrombin formation and coronary mural thrombosis. METHODS AND RESULTS:To investigate 1) whether monocyte activation is responsible for the enhanced thrombi...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.86.3.790

    authors: Serneri GG,Abbate R,Gori AM,Attanasio M,Martini F,Giusti B,Dabizzi P,Poggesi L,Modesti PA,Trotta F

    更新日期:1992-09-01 00:00:00

  • Quantitative assessment of right and left ventricular growth in the human fetal heart: a pathoanatomic study.

    abstract::We quantitated the growth patterns of the normal fetal heart and the right and left ventricles from postmortem hearts obtained from 55 spontaneously aborted human fetuses from the completion of cardiogenesis to term. Fetal gestational age was assessed by menstrual history of the mother, crown-rump length, head circumf...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.70.6.935

    authors: St John Sutton MG,Raichlen JS,Reichek N,Huff DS

    更新日期:1984-12-01 00:00:00

  • Frequency of early occlusion and stenosis in a left internal mammary artery to left anterior descending artery bypass graft after surgery through a median sternotomy on conventional bypass: benchmark for minimally invasive direct coronary artery bypass.

    abstract:BACKGROUND:Uncertainty exists regarding the frequency of early occlusion when the left internal mammary artery (LIMA) is anastomosed to the left anterior descending artery (LAD) through a sternotomy with conventional coronary artery bypass grafting (CABG). The issue has gained importance for comparison with less invasi...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1161/01.cir.100.23.2353

    authors: Berger PB,Alderman EL,Nadel A,Schaff HV

    更新日期:1999-12-07 00:00:00

  • Reentry within the atrioventricular node: surgical cure with preservation of atrioventricular conduction.

    abstract::Paroxysmal supraventricular tachycardia (PSVT) is commonly caused by reentry within the atrioventricular (AV) node. This arrhythmia was abolished by operative dissection of the AV junction in a patient with disabling tachycardia that was not controlled by drugs. The operation was intended to create complete AV block, ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.60.2.440

    authors: Pritchett EL,Anderson RW,Benditt DG,Kasell J,Harrison L,Wallace AG,Sealy WC,Gallagher JJ

    更新日期:1979-08-01 00:00:00

  • Oxygen uptake kinetics are determined by cardiac function at onset of exercise rather than peak exercise in patients with prior myocardial infarction.

    abstract:BACKGROUND:Resting cardiac function does not necessarily affect exercise capacity. However, to determine whether it affects early dynamics of oxygen uptake (VO2) during exercise, we measured VO2 during a constant work rate and during incremental exercise testing in patients with a history of myocardial infarction. VO2 ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.90.5.2324

    authors: Koike A,Hiroe M,Adachi H,Yajima T,Yamauchi Y,Nogami A,Ito H,Miyahara Y,Korenaga M,Marumo F

    更新日期:1994-11-01 00:00:00

  • Transluminal angioplasty: correlation of morphologic and angiographic findings in an experimental model.

    abstract::The morphologic consequences of transluminal angioplasty of stenotic atherosclerotic coronary arteries are unknown. This study describes the production of aortoiliac atherosclerosis in rabbits and reports the morphologic changes after transluminal angioplasty of stenotic arterial lesions. Atherosclerotic lesions were ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.61.4.778

    authors: Block PC,Baughman KL,Pasternak RC,Fallon JT

    更新日期:1980-04-01 00:00:00

  • Vasopressor response to angiotensin II infusion in patients with chronic heart failure receiving beta-blockers.

    abstract:BACKGROUND:A synergistic interaction between the angiotensin II (Ang II) type 1 receptor and alpha1-adrenergic receptors has been described. We hypothesized that the nonselective beta-antagonist carvedilol, through its alpha1-adrenergic blocking properties, may modulate vascular reactivity to Ang II in patients with ch...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.cir.0000045666.04794.14

    authors: Vittorio TJ,Lang CC,Katz SD,Packer M,Mancini DM,Jorde UP

    更新日期:2003-01-21 00:00:00

  • Demonstration of dual atrioventricular nodal pathways utilizing a ventricular extrastimulus in patients with atrioventricular nodal re-entrant paroxysmal supraventricular tachycardia.

    abstract::In patients with atrioventricular (A-V) nodal re-entrant paroxysmal supraventricular tachycardia (PSVT), atrial extrastimulus technique frequently reveals discontinuous A1-A2, H1-H2 curves suggestive of dual A-V nodal pathways. To further test the hypothesis that these curves in fact reflect dual A-V nodal pathways, a...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.52.5.789

    authors: Wu D,Denes P,Wyndham C,Amat-y-Leon F,Dhingra RC,Rosen KM

    更新日期:1975-11-01 00:00:00

  • Shear stress elevates endothelial cGMP. Role of a potassium channel and G protein coupling.

    abstract:BACKGROUND:The endothelium acts as the sensor of shear stress and as the mediator of flow-induced changes in vessel tone and structure. The purpose of this study was to delineate the signal transduction pathway of flow-induced release of endothelium-derived relaxing factor (EDRF). METHODS AND RESULTS:We used a shear s...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.88.1.193

    authors: Ohno M,Gibbons GH,Dzau VJ,Cooke JP

    更新日期:1993-07-01 00:00:00

  • S-nitrosoglutathione reduces the rate of embolization in humans.

    abstract:BACKGROUND:Antiplatelet agents presently used in the secondary prevention of cardiovascular disease fail to prevent the majority of cases of recurrent stroke and systemic embolization. An evaluation of the efficacy of new agents is hampered by a lack of in vivo models in humans. Asymptomatic cerebral embolic signals (E...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.cir.98.14.1372

    authors: Molloy J,Martin JF,Baskerville PA,Fraser SC,Markus HS

    更新日期:1998-10-06 00:00:00

  • The new 99mTc myocardial perfusion imaging agents: 99mTc-sestamibi and 99mTc-teboroxime.

    abstract::The two new 99m (99mTc) labeled myocardial perfusion agents, 99mTc-Sestamibi and 99mTc-Teboroxime, are now available for routine clinical application. Both agents allow assessment of ejection fraction by the first-pass technique at rest or during exercise, thus providing additional information not available with thall...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究,评审

    doi:

    authors: Berman DS,Kiat H,Maddahi J

    更新日期:1991-09-01 00:00:00

  • The risk of coronary bypass surgery for patients with postinfarction angina.

    abstract::Three hundred consecutive patients who developed unstable postinfarction angina requiring isolated coronary artery bypass from 1982 through 1987 were analyzed. Hospital mortality was 5%; 15 (5.5%) additional late deaths occurred during the 69-month follow-up period (mean follow-up, 23.3 months). Significant independen...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Gardner TJ,Stuart RS,Greene PS,Baumgartner WA

    更新日期:1989-06-01 00:00:00

  • High-frequency jet ventilation for respiratory failure after congenital heart surgery.

    abstract:BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is considered when respiratory failure (RF) persists despite increasing conventional mechanical ventilation (CMV). High-frequency jet ventilation (HFJV) can improve ventilation with comparable mean airway pressure (PAW) to that found on CMV. This study was undertake...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Kocis KC,Meliones JN,Dekeon MK,Callow LB,Lupinetti FM,Bove EL

    更新日期:1992-11-01 00:00:00

  • Epinephrine increases the severity of postresuscitation myocardial dysfunction.

    abstract:BACKGROUND:Epinephrine has been the mainstay for cardiac resuscitation for more than 30 years. Its vasopressor effect by which it increases coronary perfusion pressure is likely to favor initial resuscitation. Its beta-adrenergic action, however, may have detrimental effects on postresuscitation myocardial function whe...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.92.10.3089

    authors: Tang W,Weil MH,Sun S,Noc M,Yang L,Gazmuri RJ

    更新日期:1995-11-15 00:00:00

  • Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men.

    abstract:BACKGROUND:The role of a cluster of risk factors characteristic for the insulin resistance syndrome as a predictor for coronary heart disease (CHD) has not been studied previously. METHODS AND RESULTS:Clustering of cardiovascular risk factors was analyzed by factor analysis to investigate whether these clusters (facto...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.100.2.123

    authors: Lempiäinen P,Mykkänen L,Pyörälä K,Laakso M,Kuusisto J

    更新日期:1999-07-13 00:00:00

  • Improvement in survival and cardiac metabolism after gene transfer of sarcoplasmic reticulum Ca(2+)-ATPase in a rat model of heart failure.

    abstract:BACKGROUND:In heart failure, sarcoplasmic reticulum (SR) Ca(2+)-ATPase (SERCA2a) activity is decreased, resulting in abnormal calcium handling and contractile dysfunction. We have previously shown that increasing SERCA2a expression by gene transfer improves ventricular function in a rat model of heart failure created b...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/hc3601.095574

    authors: del Monte F,Williams E,Lebeche D,Schmidt U,Rosenzweig A,Gwathmey JK,Lewandowski ED,Hajjar RJ

    更新日期:2001-09-18 00:00:00

  • Effects of propranolol and nifedipine on exercise-induced attack in patients variant angina: assessment by exercise thallium-201 myocardial scintigraphy with quantitative rotational tomography.

    abstract::To examine the effects of propranolol and nifedipine on exercise-induced attack in patients with variant angina, exercise 201Tl myocardial scintigraphy with quantitative analysis by emission-computed tomography was performed in 20 patients with variant angina after oral propranolol (80 mg), nifedipine (20 mg), and pla...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.cir.74.2.374

    authors: Kugiyama K,Yasue H,Horio Y,Morikami Y,Fujii H,Koga Y,Kojima A,Takahashi M

    更新日期:1986-08-01 00:00:00

  • Effect of difficulty affording health care on health status after coronary revascularization.

    abstract:BACKGROUND:An objective of the United States' Healthy People 2010 Initiative is to eliminate disparities based on socioeconomic status. We assessed the effect of difficulty affording health care on the health status (symptoms, function, and quality of life) of patients treated with percutaneous coronary intervention or...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.104.474775

    authors: Spertus J,Decker C,Woodman C,House J,Jones P,O'Keefe J,Borkon AM

    更新日期:2005-05-24 00:00:00

  • Predictors of outcomes in low-flow, low-gradient aortic stenosis: results of the multicenter TOPAS Study.

    abstract:BACKGROUND:Patients with low-flow, low-gradient aortic stenosis have a poor prognosis with conservative therapy but a high operative mortality if treated surgically. Recently, we proposed a new index of aortic stenosis severity derived from dobutamine stress echocardiography, the projected aortic valve area at a normal...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.107.757427

    authors: Clavel MA,Fuchs C,Burwash IG,Mundigler G,Dumesnil JG,Baumgartner H,Bergler-Klein J,Beanlands RS,Mathieu P,Magne J,Pibarot P

    更新日期:2008-09-30 00:00:00

  • Comparison of echocardiographic dyssynchrony assessment by tissue velocity and strain imaging in subjects with or without systolic dysfunction and with or without left bundle-branch block.

    abstract:BACKGROUND:Several echocardiographic dyssynchrony indexes have been proposed to identify responders to cardiac resynchronization therapy using tissue velocity and strain. The present study aimed to compare tissue velocity-derived and strain-derived dyssynchrony indexes in patients with or without systolic dysfunction a...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.107.733675

    authors: Miyazaki C,Powell BD,Bruce CJ,Espinosa RE,Redfield MM,Miller FA,Hayes DL,Cha YM,Oh JK

    更新日期:2008-05-20 00:00:00

  • Evaluation of infradiaphragmatic total anomalous pulmonary venous connection with two-dimensional echocardiography.

    abstract::In three newborn infants with infradiaphragmatic total anomalous pulmonary venous connection, the common pulmonary vein was visualized with two-dimensional echocardiography and validated with saline contrast injections. The transducer was placed in the subcostal region in a sagittal body plane so as to image the desce...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.66.5.1129

    authors: Snider AR,Silverman NH,Turley K,Ebert PA

    更新日期:1982-11-01 00:00:00

  • 17beta-estradiol antagonizes cardiomyocyte hypertrophy by autocrine/paracrine stimulation of a guanylyl cyclase A receptor-cyclic guanosine monophosphate-dependent protein kinase pathway.

    abstract:BACKGROUND:Significant gender-related differences exist in the development of left ventricular hypertrophy (LVH). In addition, administration of 17beta-estradiol (E2) to ovariectomized female mice attenuates the development of LVH, demonstrating an antagonistic role for E2 in this process, although no molecular mechani...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000105682.85732.BD

    authors: Babiker FA,De Windt LJ,van Eickels M,Thijssen V,Bronsaer RJ,Grohé C,van Bilsen M,Doevendans PA

    更新日期:2004-01-20 00:00:00

  • Effect of slow pathway ablation on ventricular rate during atrial fibrillation. Dependence on electrophysiological properties of the fast pathway.

    abstract:BACKGROUND:Catheter ablation of the posteroseptal right atrium has been proposed for control of ventricular rate in patients with tachycardic atrial fibrillation (AF). However, the exact mechanism of rate control is unclear. Because the ablation site corresponds to the location of the slow pathway in patients with AV n...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.93.2.277

    authors: Kreiner G,Heinz G,Siostrzonek P,Gössinger HD

    更新日期:1996-01-15 00:00:00

  • Electrode system influence on biphasic waveform defibrillation efficacy in humans.

    abstract:BACKGROUND:Several clinical studies have demonstrated a general superiority of biphasic waveform defibrillation compared with monophasic waveform defibrillation using epicardial lead systems. To test the breadth of utility of biphasic waveforms in humans, a prospective, randomized evaluation of defibrillation efficacy ...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.84.2.665

    authors: Bardy GH,Troutman C,Johnson G,Mehra R,Poole JE,Dolack GL,Kudenchuk PJ,Gartman DM

    更新日期:1991-08-01 00:00:00

  • Oral everolimus inhibits in-stent neointimal growth.

    abstract:BACKGROUND:Rapamycin (sirolimus)-eluting stents are associated with reduced restenosis rates in animal studies and initial human trials. The present study evaluated whether orally administered everolimus (a macrolide of the same family as sirolimus) inhibits in-stent neointimal growth in rabbit iliac arteries. METHODS...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.0000033973.06059.04

    authors: Farb A,John M,Acampado E,Kolodgie FD,Prescott MF,Virmani R

    更新日期:2002-10-29 00:00:00