Friedrich M. Fruhwald, Astrid Fahrleitner-Pammer, Barbara Obermayer-Pietsch, Michael A. Goulder, Henry Krum, Dirk J. van Veldhuisen, Louis van de Ven, Patricia Verkenne, Burkert Pieske, Wilfried Meyer , Ronnie Willenheimer
Department of Cardiology, University Clinic of Internal Medicine, Auenbruggerplatz 15, A-8036 Graz, Austria.
Although neurohormones have a well-established prognostic value in patients with chronic heart
failure (CHF), little is known about this in CHF patients untreated with angiotensin-converting enzyme (ACE)-inhibitors,
angiotensin-receptor blockers (ARBs) and beta-blockers.
Baseline N-terminal pro atrial natriuretic peptide (NT-pro-ANP), N-terminal pro B-type natriuretic peptide (NTpro-BNP), big endothelin (big-ET) and arginine-vasopressin (AVP) were tested for prognostic importance to predict the
primary endpoint (death or hospitalisation) in 109 patients participating in the third Cardiac Insufficiency BIsoprolol
Study(CIBIS III). Minimum follow-up time was 12 months (6 months monotherapy followed by 6 months combinationtherapy).
On average, patients had moderate elevation of all neurohormones tested. In univariate analysis, both belowmedian NT-pro-BNP (HR 0.37, 95% confidence interval [CI] 0.17-0.81, p=0.013) and below-median big-ET (HR 0.39,
95% CI 0.18-0.86, p=0.02) predicted decreased risk of all-cause death or hospitalisation, compared with above-median
values. NT-pro-BNP lost its predictive power in multivariate analysis, while big-ET above median as well as body mass
index (BMI) below median and presence of ischemic heart disease were predictive of increased risk of death or hospitalisation.
Using Cox stepwise regression analysis, only BMI (p=0.011) and big-ET (p=0.003) remained significant predictors
of death or hospitalisation.
In a cohort of elderly CHF patients naïve of ACE-inhibitors, ARBs and beta-blockers, the best predictors of
all-cause death or hospitalisation were a low BMI and elevated levels of big-endothelin.