Relationship between intrarenal renin-angiotensin activity and re-hospitalization in patients with heart failure with reduced ejection fraction

Özet

Objective: Heart failure (HF) is a clinical syndrome resulting from structural or functional damages. Although clinical trials have shown that theplasma renin–angiotensin system (RAS) activation decreases HF functional status and increases hospitalization for HF patients, the effect ofintrarenal RAS activity is still unknown. In this study, we investigated the relationship between the New York Heart Association (NYHA) class,duration, and number of hospitalizations in the previous year and urinary angiotensinogen (UAGT) in patients with HF with reduced ejectionfraction (HFrEF).Methods: This study included 85 patients who had an ejection fraction of <40% and were receiving optimal medical treatment. Among these, 22were excluded from the study for various reasons. Demographically and biochemically, the remaining 63 patients were compared according tothe NYHA functional classes and re-hospitalization status.Results: When the groups were compared in terms of N-terminal pro–B-type natriuretic peptide (NT-proBNP), UAGT, and high-sensitivity Creactiveprotein (Hs-CRP), it was found that these parameters were significantly higher in patients who were hospitalized more than two timesin the previous year [p<0.001; p=0.007; p<0.001, respectively]. There was a significant correlation between number of hospitalizations and NTproBNP(r=0.507, p<0.001), Hs-CRP (r=0.511, p<0.001), hemoglobin (r=0.419, p=0.001), serum sodium (r=0.26, p=0.04), and systolic blood pressure(r=0.283, p=0.02). When the independence of multiple correlations was assessed using multiple linear regression analysis, NT-proBNP,Hs-CRP, and hemoglobin levels were independent predictors of re-hospitalization, but this was not the same for UAGT.Conclusion: Although UAGT levels are high in patients with poor NYHA functional class and repeated hospitalizations, this marker is not valuable for predicting repeated hospitalization in patients with HFrEF.