Plasma Norepinephrine as a Guide to Prognosis in Patients with Chronic Congestive Heart Failure

Cohn, Jay N.; Levine, T. Barry; Olivari, Maria Teresa; Garberg, Victoria; Lura, Dennis; Francis, Gary S.; Simon, Ada B.; Rector, Thomas

doi:10.1056/nejm198409273111303

Cited by 3,125Heart Failure Treatment and ManagementElectrolyte and hormonal disordersCardiac Fibrosis and Remodeling

Plasma Norepinephrine as a Guide to Prognosis in Patients with Chronic Congestive Heart Failure

Cohn, Jay N., Levine, T. Barry, Olivari, Maria Teresa, Garberg, Victoria, Lura, Dennis, Francis, Gary S., Simon, Ada B., Rector, Thomas·1984·New England Journal of Medicine

DOI 10.1056/nejm198409273111303

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Abstract

Hemodynamics, plasma norepinephrine, and plasma renin activity were measured at supine rest in 106 patients (83 men and 23 women) with moderate to severe congestive heart failure. During follow-up lasting 1 to 62 months, 60 patients died (57 per cent); 47 per cent of the deaths were sudden, and 45 per cent were related to progressive heart failure. Statistically unrelated to the risk of mortality were cause of disease (60 patients had coronary disease, and 46 had cardiomyopathy), age (mean, 54.8 years), cardiac index (mean, 2.11 liters per minute per square meter of body-surface area), pulmonary wedge pressure (mean, 24.5 mm Hg), and mean arterial pressure (mean, 83.2 mm Hg). A multivariate analysis of the five significant univariate prognosticators--heart rate (mean, 84.4 beats per minute), plasma renin activity (mean, 15.4 ng per milliliter per hour), plasma norepinephrine (mean, 700 pg per milliliter), serum sodium (mean, 135.7 mmol per liter), and stroke-work index (mean, 21.0 g-meters per square meter)--found only plasma norepinephrine to be independently (P = 0.002) related to the subsequent risk of mortality. Norepinephrine was also higher in patients who died from progressive heart failure than in those who died suddenly. These data suggest that a single resting venous blood sample showing the plasma norepinephrine concentration provides a better guide to prognosis than other commonly measured indexes of cardiac performance.

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In cardiac failure, the level of elevation of the plasma concentration of norepinephrine predicts reduced longevity.
“A prime example is provided by cardiac failure, where the level of elevation of the plasma concentration of norepinephrine in plasma predicts reduced longevity.18”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [18]
Ongoing systemic sympathetic activation has long been thought to be noxious in heart failure and renal failure.
“Ongoing systemic sympathetic activation has long been thought to be noxious, in heart failure 18,19 and renal failure.113”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [18]

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Authors: Cohn, J. N., Levine, T. B., Olivari, M. T., Garberg, V., Lura, D., Francis, G. S., Simon, A. B., & Rector, T.
Affiliations: University of Minnesota (US)
ORCID: Cohn, Jay N.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1984-09-27
Volume: 311
Issue: 13
Pages: 819-823
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm198409273111303
OpenAlex: W2338638760
Cited by: 3,125
References: 23
Citations by year: 2026: 22 · 2025: 30 · 2024: 22 · 2023: 44 · 2022: 50 · 2021: 49 · 2020: 54 · 2019: 58 · 2018: 42 · 2017: 57 · 2016: 75 · 2015: 73 · 2014: 101 · 2013: 87 · 2012: 88
FWCI: 34.36
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
Keywords: plasma norepinephrine, congestive heart failure, prognosis, mortality risk, plasma renin activity, hemodynamics, sudden death, progressive heart failure, prognostic factors, heart rate, stroke work index, serum sodium
MeSH terms: Age Factors, Blood Pressure, Female, Follow-Up Studies, Heart Failure, Heart Rate, Hemodynamics, Humans, Male, Middle Aged, Norepinephrine, Prognosis, Pulmonary Wedge Pressure, Renin

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Plasma Norepinephrine as a Guide to Prognosis in Patients with Chronic Congestive Heart Failure

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