CARDIAC RISK STRATIFICATION IN PATIENTS WITH CONGESTIVE HEART FAILURE:A CATECHOLAMINES-β-ADRENOCEPTOR-cAMP PATHWAY  

作　　者：Ying-xinPeng JiangShan Su-junZhang Chun-liRong Jun-pingLi NaWang HaoXue Shi-lingZheng MinWu 

机构地区：[1]DepartmentofCardiology,SecondAffiliatedHospital,SchoolofMedicine,ZhejiangUniversity,Hangzhou310027 [2]DepartmentofInternalMedicine,CenteronHebeiProvincialPreventionandTreatmentofHighBloodPressure,andCardiacCenterofHebeiProvincialPeople＇sHospital,Shijiazhuang050051 [3]DepartmentofBiochemistryandMolecularBiology,CollegeofLifeSciences,ZhejiangUniversity,Hangzhou310027

出　　处：《Chinese Medical Sciences Journal》2005年第2期93-98,共6页中国医学科学杂志（英文版）

基　　金：Supported by a research foundation of Hebei Provincial Science and Technology Commitee (399413 ).

摘　　要：Objective To investigate the stratification risk of catecholamines-β-adrenoceptor (β-AR)-cAMP pathway for cardiogenic death events in patients with congestive heart failure (CHF). Methods A total of 83 identified CHF patients with a baseline and follow-up plasma levels of norepinephrine (NE) and epinephrine (E), lymphocytes β-AR density (Bmax), and intralymphocyte cAMP content in peripheral blood were followed up. Major cardiogenic death events were registered. Results The period between the initial entry and the last follow-up measurement were 51±16 months, the total duration of clinical follow-up after the last measurement were 14±8 months. During follow-up, 39 patients died of cardiogenic (sudden death 17 patients, worsening heart failure 22 patients). Persistence of high NE, E, and cAMP from baseline to follow-up were confirmed as risk predicting factors of cardiovascular events. Persistence NE above 4.0 nmol/L, E above 3.5 nmol/L, and the intralymphocyte cAMP content above 3.5 pmd·mg-1·pro-1 from baseline to follow-up were significant adverse prognostic predictors. The major cardiogenic death events rates per 100 patients-years were 1.33 and 4.82 in patients with NE below and above 4.0 nmol/L (HR: 2.91; 95% CI: 1.08-7.33; P = 0.015); were 1.42 and 4.36 in the patients with E levels below and above 3.5 nmol/L (HR: 2.64; 95% CI: 1.02-6.41; P = 0.019); were 1.81 and 4.67 in the patients with the intralymphocyte cAMP content below and above 3.5 pmd·mg-1·pro-1 (HR: 2.79; 95% CI: 1.04-6.83; P = 0.017), but difference was not significant between the β-AR density below and above median. Conclusions Persistent increase in circulating catecholamines and intralymphocyte cAMP content may increase the long-term mortality in CHF patients.

关 键 词：heart failure CATECHOLAMINE Β-ADRENOCEPTOR cyclic adenosine monophosphate 

分 类 号：R541.6[医药卫生—心血管疾病]