TY - JOUR
T1 - Increasing serum soluble angiotensin-converting enzyme 2 activity after intensive medical therapy is associated with better prognosis in acute decompensated heart failure
AU - Shao, Zhili
AU - Shrestha, Kevin
AU - Borowski, Allen G.
AU - Kennedy, David J.
AU - Epelman, Slava
AU - Thomas, James D.
AU - Tang, W. H Wilson
N1 - Funding Information:
Funding: National Institutes of Health grant 1R01HL103931 (W.H.W.T.), Cleveland Clinic Clinical Research Unit of the Cleveland Clinic/Case Western Reserve University grant CTSA 1UL1TR000439 (W.H.W.T., A.G.B.), American College of Cardiology Foundation (W.H.W.T.), and American Society of Echocardiography (A.G.B.).
Funding Information:
Dr Tang has received research grant support from Abbott Laboratories . No other disclosures are reported.
PY - 2013/9
Y1 - 2013/9
N2 - Background Angiotensin-converting enzyme 2 (ACE2) is an endogenous counterregulator of the renin-angiotensin system that has been recently identified in circulating form. We aimed to investigate the relationship among changes in soluble ACE2 (sACE2) activity, myocardial performance, and long-term clinical outcomes in patients with acute decompensated heart failure (ADHF). We hypothesized that increasing sACE2 activity levels during intensive medical treatment are associated with improved myocardial performance and long-term clinical outcomes. Methods and Results In 70 patients admitted to the intensive care unit with ADHF, serum sACE2 activity levels, echocardiographic data, and hemodynamic variables were collected within 12 hours of admission (n = 70) and 48-72 hours after intensive medical treatment (n = 57). The median [interquartile range] baseline and 48-72-hour serum sACE2 activity levels were 32 [23-43] ng/mL and 40 [28-60] ng/mL, respectively. Baseline serum sACE2 activity levels correlated with surrogate measures of right ventricular diastolic dysfunction, including right atrial volume index (RAVi; r = 0.31; P =.010), tricuspid E/A ratio (r = 0.39; P =.007), and B-type natriuretic peptide (r = 0.32; P =.008). However, there were no correlations between serum sACE2 and left ventricular systolic or diastolic dysfunction. After intensive medical therapy, a 50% increase in baseline serum sACE2 levels predicted a significant reduction in risk of death, cardiac transplantation, or ADHF rehospitalization, including after adjustment for baseline age, RAVi, and BNP levels (hazard ratio 0.35, 95% confidence interval 0.12-0.84; P =.018). Conclusions In patients admitted with ADHF, increasing serum sACE2 activity levels during intensive medical therapy predict improved outcomes independently from underlying cardiac indices.
AB - Background Angiotensin-converting enzyme 2 (ACE2) is an endogenous counterregulator of the renin-angiotensin system that has been recently identified in circulating form. We aimed to investigate the relationship among changes in soluble ACE2 (sACE2) activity, myocardial performance, and long-term clinical outcomes in patients with acute decompensated heart failure (ADHF). We hypothesized that increasing sACE2 activity levels during intensive medical treatment are associated with improved myocardial performance and long-term clinical outcomes. Methods and Results In 70 patients admitted to the intensive care unit with ADHF, serum sACE2 activity levels, echocardiographic data, and hemodynamic variables were collected within 12 hours of admission (n = 70) and 48-72 hours after intensive medical treatment (n = 57). The median [interquartile range] baseline and 48-72-hour serum sACE2 activity levels were 32 [23-43] ng/mL and 40 [28-60] ng/mL, respectively. Baseline serum sACE2 activity levels correlated with surrogate measures of right ventricular diastolic dysfunction, including right atrial volume index (RAVi; r = 0.31; P =.010), tricuspid E/A ratio (r = 0.39; P =.007), and B-type natriuretic peptide (r = 0.32; P =.008). However, there were no correlations between serum sACE2 and left ventricular systolic or diastolic dysfunction. After intensive medical therapy, a 50% increase in baseline serum sACE2 levels predicted a significant reduction in risk of death, cardiac transplantation, or ADHF rehospitalization, including after adjustment for baseline age, RAVi, and BNP levels (hazard ratio 0.35, 95% confidence interval 0.12-0.84; P =.018). Conclusions In patients admitted with ADHF, increasing serum sACE2 activity levels during intensive medical therapy predict improved outcomes independently from underlying cardiac indices.
KW - Soluble angiotensin-converting enzyme 2
KW - acute decompensated heart failure
KW - right ventricular diastolic dysfunction
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U2 - 10.1016/j.cardfail.2013.06.296
DO - 10.1016/j.cardfail.2013.06.296
M3 - Article
C2 - 24054336
AN - SCOPUS:84884539433
SN - 1071-9164
VL - 19
SP - 605
EP - 610
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 9
ER -