Renin Feedback Is an Independent Predictor of Outcome in HFpEF

Figures

• 

  Figure 1. Angiotensin metabolism and RAAS Triple-A analysis. Angiotensinogen is produced in the liver and converted to angiotensin I by enzymatic cleavage via renin. Angiotensin I is further metabolized to angiotensin II by angiotensin converting enzyme, which binds to the angiotensin II type 1 receptor (AT1R), inducing vasoconstriction and secretion of aldosterone from the adrenal cortex. In RAAS Triple-A analysis, angiotensin-based markers for plasma renin activity (PRA-S), ACE activity (ACE-S) and adrenal AT1R signaling (AA2-Ratio) are calculated as indicated.

• 

  Figure 2. Value distribution for Ang I, Ang II and Aldosterone. Graphs show individual values for indicated analytes. The median is indicated as a horizontal line.

• 

  Figure 3. Value distribution for PRA-S, ACE-S and AA2-Ratio. Graphs show individual values for indicated analytes. The median is indicated as a horizontal line.

• 

  Figure 4. RAAS Triple-A illustrations visualizing serum concentrations of Ang I, Ang II and aldosterone. Numbers refer to median serum equilibrium concentrations in (pmol/L). Median valued for patient groups without renin angiotensin-inhibiting therapy (n = 39), on ACEi therapy (n = 45) and on ARB treatment (n = 66) are shown as indicated. Corresponding median values for PRA-S, ACE-S and AA2-Ratio are shown in (pmol/L), ((pmol/L)/(pmol/L)) and ((pmol/L)/(pmol/L)), respectively. RAASi indicates renin angiotensin system inhibitors; ACEi, angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blockers; Ang, angiotensin; REN, renin; ACE, angiotensin converting enzyme; AT1R, angiotensin II type 1 receptor; Aldo, aldosterone; PRA-S: plasma renin activity in (pmol/L); ACE-S: ACE activity in ((pmol/L)/(pmol/L)); AA2-Ratio: Aldosterone-to-Ang II ratio in ((pmol/L)/(pmol/L)).

• 

  Figure 5. (A) Kaplan–Meier analysis for all-cause death between therapy groups in the total study cohort (n = 150). (B) Kaplan–Meier analysis for time to all-cause death, shown for patients with high- versus low levels of Angiotensin II, separated by median Angiotensin II levels. (C) Kaplan–Meier analysis for time to all-cause death, shown for patients with high versus low plasma renin activity (PRA), separated by median plasma renin levels. ACEi indicates angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blockers; RASi, renin angiotensin system inhibitors, which includes ACEi and ARB.