Elevated RAAS profiles (RAAS+/+) in acute heart failure were associated with lower urine sodium at admission and increased risks of one-year mortality or HF rehospitalization (p<0.001).
Cohort (n=211)
No
Does RAAS overactivity correlate with adverse clinical outcomes and decongestive ability in patients with acute heart failure?
Elevated RAAS activity in acute heart failure is a marker of advanced disease, low natriuresis, and increased risk of one-year mortality or HF rehospitalization.
p-value: p=<0.001
BACKGROUND: Although renin-angiotensin-aldosterone system (RAAS) activation is believed to be the major driver of acute heart failure (AHF) episodes our understanding of its prevalence and clinical relevance in contemporary settings is incomplete. METHODS: Serum renin and aldosterone were measured at day-1 and at discharge in patients (n = 211) that were hospitalized between 2016 and 2017 for AHF in a single cardiology center. The population was profiled based on upper limits of normal (ULN) of both biomarkers assessed at day-1 and linked with the clinical course and outcomes. RESULTS: The study population constituted of three profiles: RAAS-/- (n = 121 57%); RAAS+/- (n = 60 28%); and RAAS+/+ (n = 30 14%). The RAAS+/+ profile had the lowest blood pressure and serum sodium at admission, day-2 and discharge compared to the other profiles (p < 0.001). The RAAS+/+ patients had significantly lower urine Na+ at admission (57.8 ± 36.7 vs 97.3 ± 31.3 and 86.4 ± 35.0), day-1 (52.7 ± 32.7 vs 85.3 ± 36.3 and 75.5 ± 33.9) mmol/l, vs RAAS-/- and RAAS+/- profiles, respectively, all p < 0.001. There was also a gradual decrease of renal function across increasing RAAS profiles. The RAAS+/+ profile received higher dose of furosemide at discharge 120 80-160 vs the other profiles 80 40-120 mg, p < 0.01. The risks of one year mortality or HF rehospitalization increased across the RAAS profiles (p < 0.001). The trajectory of renin or aldosterone change during hospitalization was not related to outcomes. CONCLUSIONS: The RAAS overactivity is not essential for development of AHF. However, elevated RAAS is a marker of more advanced stages of heart failure, is related to low natriuresis and adverse clinical outcomes.
Biegus et al. (2021) conducted a cohort in Acute heart failure (n=211). RAAS profiles (renin and aldosterone levels) vs. RAAS-/- and RAAS+/- profiles was evaluated on One year mortality or HF rehospitalization (p=<0.001). Elevated RAAS profiles (RAAS+/+) in acute heart failure were associated with lower urine sodium at admission and increased risks of one-year mortality or HF rehospitalization (p<0.001).