Low cardiac output stimulates vasopressin release in patients with stage D heart failure – Its relevance to poor prognosis and reversal by surgical treatment –

Teruhiko Imamura, Masaru Hatano, Takeo Fujino, Toshiro Inaba, Hisataka Maki, Issei Komuro, Koichiro Kinugawa, Shunei Kyo, Osamu Kinoshita, Kan Nawata, Minoru Ono

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Background: Depressed hemodynamics stimulates arginine vasopressin (AVP) release, but the relationship between plasma AVP levels (P-AVP) and cardiac parameters, especially in patients with stage D heart failure (HF) receiving guideline-directed medical therapy, has not examined.

Methods and Results: Data including P-AVP were obtained from 162 in-hospital patients with stage D HF and from 80 patients receiving ventricular assist device (VAD, n=46) or heart transplantation (HTx, n=34) at 3 months after surgery. In the HF group, considerably high P-AVP (5.9±6.1 pg/ml) negatively correlated with serum sodium concentration (S-Na, 135.3±5.8 mEq/L, r=–0.548 [P<0.01]) and cardiac index (CI, 2.2±0.5 L•min–1•m–2, r=–0.458 [P<0.01]). After VAD/HTx treatment, improvement in the CI (2.7±0.5 L•min–1•m–2[P<0.01] vs. HF) was accompanied by normalization of serum sodium concentration (S-Na; 138.2±2.0 mEq/L [P<0.01] vs. HF) and suppressed release of AVP (1.7±3.4 pg/ml [P<0.01] vs. HF). P-AVP positively correlated with only S-Na (r=0.454 [P<0.01]), whereas no correlation was observed with CI after VAD/HTx treatment. P-AVP ≥5.3 pg/ml well predicted poor 2-year survival in HF group (60% [P<0.01] vs. 90%).

Conclusions: Low cardiac output stimulates AVP release via a non-osmotic process that results in hyponatremia and poor prognosis in patients with stage D HF. After sufficient recovery of cardiac output by cardiac replacement therapy, AVP release is suppressed and is mainly regulated by serum osmolality.

Original languageEnglish
Pages (from-to)2259-2267
Number of pages9
JournalCirculation Journal
Issue number9
Publication statusPublished - Sep 1 2014


All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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