Hyponatremia, the activation of the Renin- Angiotensin- Aldosterone System (RAAS) and the Ariginine-Vasopressin (AVP) are negative prognostic factors in patients with Heart Failure (HF). Data on the relationship between these variables and Neurohormonal activation are limited, in particular for what concerns the AVP. We studied the sodium balance, the changes in levels of Aldosterone, Renin, Copeptin (stable fragment of the pre-pro-vasopressin) and NT-proBNP after intravenous diuretic therapy in 30 patients with HF in NYHA class III -IV, referred to our Day Hospital who required intravenous diuretic therapy. A sample for hormones was performed before infusion of furosemide ( t = 0) and after 4 hours (t = 4 ). All patients had a 24 hour urine collection the day before the intravenous therapy and completed a questionnaire on the take weekly sodium with diet. The results showed a significant increase in the values of Aldosterone: in clinostatism: t0 : 209,9 ± 135 pg / ml ; t4: 410,1 ± 214,4 pg / ml ( p < 0,0001); in orthostatism : t0: 297,6 ± 224,9 pg/ml ; t4: 354,3± 161,2 pg/ml ( p = 0,11). The Renin values are: clinostatism: t0 : 10,98 ± 9,43 ng / ml / h ; t4: 20,53 ± 13,64 ng / ml / h (p = 0,009); orthostatism: t0: 10,64 ± 9,08 ng/ml/h ; t4:20,52± 13,6 ng/ml/h ( p = 0,0002). The Copeptin increased after therapy: t0 30,31 ± 4,544 pg / ml ; t4 = 36,54 ± 12,05 pg / ml ( p = 0,02 ). The values of NT-proBNP were similar to t0 and t4 ( p = 0,7). The ten hyponatraemic patients (Group 1) had values of Aldosterone, Renin, Copeptin and NT-proBNP more than the others (Group 2). The sodium intake in the diet was similar in the two groups; in Group 1, the sodium excretion of 24 h was 17% higher than Group 2. The home diuretic therapy in the two groups was higher in Group 2; Group 1: 612.5 ± 583.04 mg; Group 2: 1806.78 ± 914.7 mg. intravenous diuretic therapy in patients with HF induces a Neurohormonal activation with increase of Copeptin and components of the RAAS. NT-proBNP will not change, probably for the short period of observation. The hyponatraemic patients had a greater hormonal activation at baseline and after therapy, and this supports the view of considering hyponatremia an adverse prognostic factor in patients with HF. Our results help to clarify the changes induced by diuretic therapy and the relationship between it and the prognosis. This therapy should therefore be reserved for patients who absolutely require reduction of fluid overload.
Associazione Nazionale Medici Cardiologi Ospedalieri
