Abstract 830: Transcardiac Increase in Norepinephrine and Prognosis in Patients with Chronic Heart Failure

Abnormal cardiac sympathetic nerve activity (CSA) plays an important role in the pathophysiology of CHF. However, no previous study has compared the transcardiac gradient of norepinephrine (NE) and the prognosis of patients with chronic heart failure (CHF). To evaluate the prognostic role of the transcardiac gradient of NE in patients with CHF. We measured hemodynamic parameters and plasma levels of NE, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in the aortic root (AO) and coronary sinus (CS) in 356 consecutive patients with CHF. During a median follow-up of 3.5 years, 40 patients died. Transcardiac gradients of BNP (273±276 vs. 472±433 pg/mL, p<0.0001), NT-proBNP (417±700 vs. 928±1093 pg/mL, p<0.0001) and NE (114±160 vs. 473±992 pg/mL, p<0.0001) were significantly higher in non-survivors than survivors. After adjustment for clinical variables associated with CHF including hemodynamics and neurohumoral factors, the transcardiac gradient of NE (p<0.0001) and plasma log NT-proBNP (p<0.0001) were independent prognostic predictors. Among 67 patients in whom 123 I- metaiodobenzylguanidine (MIBG) could be performed, transcardiac increase in NE (ΔNE) was correlated with the washout rate (r=0.398, p=0.0009) and was a superior predictor of mortality than MIBG parameters. Patients were divided into four groups based on the cut-off levels for ΔNE and plasma NT-proBNP, and Kaplan-Meier survival curves were constructed (Figure ). The transcardiac increase in NE, as a biomarker of CSA, is an independent and useful prognostic predictor for evaluating the prognosis of CHF patients.