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Relationship between intrarenal renin-angiotensin activity and re-hospitalization in patients with heart failure with reduced ejection fraction [Anatol J Cardiol]
Anatol J Cardiol. 2018; 19(3): 205-212 | DOI: 10.14744/AnatolJCardiol.2018.68726  

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

Özcan Örsçelik1, Buğra Özkan1, Ayça Arslan1, Emre Ertan Şahin1, Ozan Sakarya1, Orçun Ali Sürmeli1, Şenay Balcı Fidancı2, Ahmet Çelik1, Burak Yavuz Çimen2, Ismail Türkay Özcan1
1Department of Cardiology, Faculty of Medicine, Mersin University; Mersin-Turkey
2Department of Biochemistry, Faculty of Medicine, Mersin University; Mersin-Turkey

Objective: Heart failure (HF) is a clinical syndrome resulting from structural or functional damages. Although clinical trials have shown that the plasma renin–angiotensin system (RAS) activation decreases HF functional status and increases hospitalization for HF patients, the effect of intrarenal 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 ejection fraction (HFrEF).
Methods: This study included 85 patients who had an ejection fraction of <40% and were receiving optimal medical treatment. Among these, 22 were excluded from the study for various reasons. Demographically and biochemically, the remaining 63 patients were compared according to the 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 C-reactive protein (Hs-CRP), it was found that these parameters were significantly higher in patients who were hospitalized more than two times in the previous year [p<0.001; p=0.007; p<0.001, respectively]. There was a significant correlation between number of hospitalizations and NT-proBNP (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.

Keywords: heart failure, plasma renin–angiotensin activity, intrarenal renin-angiotensin activity, urinary angiotensinogen


Özcan Örsçelik, Buğra Özkan, Ayça Arslan, Emre Ertan Şahin, Ozan Sakarya, Orçun Ali Sürmeli, Şenay Balcı Fidancı, Ahmet Çelik, Burak Yavuz Çimen, Ismail Türkay Özcan. Relationship between intrarenal renin-angiotensin activity and re-hospitalization in patients with heart failure with reduced ejection fraction. Anatol J Cardiol. 2018; 19(3): 205-212

Corresponding Author: Özcan Örsçelik, Türkiye


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