Key result
Neurohormonal and endothelin levels correlate strongly with hemodynamic severity in primary pulmonary hypertension.
Why the study?
Neurohormonal activation appears to parallel the severity of left heart failure, but little was known about its role in isolated right heart failure.
Cross-Sectional (n=21)
Demonstrates that neurohormonal activation and elevated endothelin levels occur in isolated right ventricular failure secondary to primary pulmonary hypertension and correlate closely with hemodynamic severity.
Answers are grounded in this paper and cite their sources.
Neurohormonal activation may track RV failure severity in PH; extends left HF observations but leaves clinical utility open.
Objectives This study sought to determine whether neurohormonal activation occurs in isolated right heart failure. Background Neurohormonal activation appears to parallel the severity of left heart failure, but little is known about its role in right heart failure. Methods We evaluated neurohormonal activation and endothelin levels in 21 patients with primary pulmonary hypertension at the time of right heart catheterization. Results Plasma norepinephrine levels correlated significantly with pulmonary artery pressure (r = 0.66, p < 0.01), cardiac index (r = -0.56, p < 0.01) and pulmonary vascular resistance (r = 0.69, p < 0.001). Atrial natriuretic peptide levels were higher in the pulmonary artery than the right atrium and femoral artery and correlated closely with pulmonary artery oxygen saturation (r = -0.73, p < 0.0001). Plasma renin levels were not elevated. Endothelin levels were increased and correlated with right atrial pressure (r = 0.74, p < 0.0001) and pulmonary artery oxygen saturation (r = -0.070, p < 0.0004). Conclusions Neurohormonal activation occurs in patients with isolated right ventricular failure and inherently normal left ventricles and appears to be related to the overall severity of cardiopulmonary derangements. The elevation in endothelin levels is consistent with its release in response to pulmonary hypertension.
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Nootens et al. (1995) conducted a cross-sectional in Primary pulmonary hypertension with isolated right ventricular failure (n=21). Neurohormonal activation (norepinephrine, atrial natriuretic peptide, renin) and endothelin levels was evaluated on Correlation of plasma neurohormonal and endothelin levels with hemodynamic variables (r = 0.69, p=<0.001). Neurohormonal and endothelin levels correlated with hemodynamic severity in primary pulmonary hypertension, including norepinephrine with PVR and endothelin with RAP.
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