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RESTORING CIRCULATING SOLUBLE ACE2 ACTIVITY FOLLOWING INTENSIVE MEDICAL THERAPY PREDICTS IMPROVEMENT IN ADVANCED DECOMPENSATED HEART FAILURE
A23.E215 JACC March 9, 2010 Volume 55, issue 10A
CARDIAC FUNCTION AND HEART FAILURE RESTORING CIRCULATING SOLUBLE ACE2 ACTIVITY FOLLOWING INTENSIVE MEDICAL THERAPY PREDICTS IMPROVEMENT IN ADVANCED DECOMPENSATED HEART FAILURE ACC Poster Contributions Georgia World Congress Center, Hall B5 Sunday, March 14, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Diagosis and Treatment of Heart Failure Abstract Category: Cardiomyopathies/Myocarditis/Pericardial Disease Presentation Number: 1066-45 Authors: Zhili Shao, Kevin L. Shrestha, Allen G. Borowski, Slava Epelman, Wai Hong Wilson Tang, Cleveland Clinic, Cleveland, OH Background: Angiotensin-converting enzyme 2 (ACE2) counteracts the renin-angiotensin system. However, the relationship between soluble ACE2 (sACE2) activity, myocardial performance and long-term outcomes in patients with advanced decompensated heart failure (ADHF) has not been examined. Methods: In 72 ADHF patients, serum sACE2 activity levels, echocardiographic and hemodynamic variables were collected at baseline (n=72) and 48-72 hours after intensive medical therapy (n=58). Results: In our study cohort (mean age 56±13 years, mean LVEF 27±9 %, mean pulmonary capillary wedge pressure [PCWP] 21±7 mmHg), median baseline and 48-72 hour sACE2 activity levels were 32 [23, 42] and 40 [28, 60] ng/mL. Baseline sACE activity correlated with indices of right ventricular (RV) diastolic dysfunction, including tricuspid E/A (Spearman’s r=0.39, p=0.007) and right atrial volume index (RAVI, global measure of RV function) (r=0.31, p=0.010), as well as BNP (r=0.32, p=0.023) but not with left ventricular (LV) systolic or diastolic dysfunction. A 50% increase in baseline sACE2 levels predicted a reduced risk of death, cardiac transplantation or HF rehospitalization independent of baseline age, RAVI, and BNP levels (HR: 0.38, 95%CI 0.13-0.91, p=0.029). Conclusions: In ADHF patients, baseline serum sACE2 activity levels are associated with RV diastolic dysfunction, while increasing sACE2 levels during intensive medical therapy predict improved outcomes independent of baseline age, RAVI and BNP levels.
CARDIAC FUNCTION AND HEART FAILURE RESTORING CIRCULATING SOLUBLE ACE2 ACTIVITY FOLLOWING INTENSIVE MEDICAL THERAPY PREDICTS IMPROVEMENT IN ADVANCED DECOMPENSATED HEART FAILURE ACC Poster Contributions Georgia World Congress Center, Hall B5 Sunday, March 14, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Diagosis and Treatment of Heart Failure Abstract Category: Cardiomyopathies/Myocarditis/Pericardial Disease Presentation Number: 1066-45 Authors: Zhili Shao, Kevin L. Shrestha, Allen G. Borowski, Slava Epelman, Wai Hong Wilson Tang, Cleveland Clinic, Cleveland, OH Background: Angiotensin-converting enzyme 2 (ACE2) counteracts the renin-angiotensin system. However, the relationship between soluble ACE2 (sACE2) activity, myocardial performance and long-term outcomes in patients with advanced decompensated heart failure (ADHF) has not been examined. Methods: In 72 ADHF patients, serum sACE2 activity levels, echocardiographic and hemodynamic variables were collected at baseline (n=72) and 48-72 hours after intensive medical therapy (n=58). Results: In our study cohort (mean age 56±13 years, mean LVEF 27±9 %, mean pulmonary capillary wedge pressure [PCWP] 21±7 mmHg), median baseline and 48-72 hour sACE2 activity levels were 32 [23, 42] and 40 [28, 60] ng/mL. Baseline sACE activity correlated with indices of right ventricular (RV) diastolic dysfunction, including tricuspid E/A (Spearman’s r=0.39, p=0.007) and right atrial volume index (RAVI, global measure of RV function) (r=0.31, p=0.010), as well as BNP (r=0.32, p=0.023) but not with left ventricular (LV) systolic or diastolic dysfunction. A 50% increase in baseline sACE2 levels predicted a reduced risk of death, cardiac transplantation or HF rehospitalization independent of baseline age, RAVI, and BNP levels (HR: 0.38, 95%CI 0.13-0.91, p=0.029). Conclusions: In ADHF patients, baseline serum sACE2 activity levels are associated with RV diastolic dysfunction, while increasing sACE2 levels during intensive medical therapy predict improved outcomes independent of baseline age, RAVI and BNP levels.