Renin Feedback Is an Independent Predictor of Outcome in HFpEF

Binder-Rodriguez, C.; Poglitsch, Marko; Duca, Franz; Rettl, René; Dachs, Theresa-Marie; Schrutka, Lore; Seirer, Benjamin; Ligios, Luciana Camuz; Capelle, C; Eslam, Roza Badr; Qin, Hong; Hengstenberg, Christian; Bonderman, Diana

doi:10.3390/jpm11050370

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…RAS Fingerprint TM is novel, liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based methodology for simultaneous quantification of multiple components of the RAAS in a single sample. Outside pregnancy, recent studies have utilized RAS Fingerprint TM (or RAS profiling) to generate a biochemical “snapshot” of the RAAS activity that is reflective of the diseased state in patients with hypertension [ 32 ], heart failure [ 33 , 34 ], and other diseases [ 35 , 36 ]. In the current study, we used RAS Fingerprint to quantify the key effectors (angiotensin peptides and aldosterone) of the RAAS in a cohort of women followed prospectively for the development of gestational hypertension and pre-eclampsia.…”

Section: Introductionmentioning

confidence: 99%

Activation of the Renin–Angiotensin–Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy

Shoemaker

Poglitsch²,

Hong

et al. 2023

IJMS

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Hypertension during pregnancy increases the risk of adverse maternal and fetal outcomes, but the mechanisms of pregnancy hypertension are not precisely understood. Elevated plasma renin activity and aldosterone concentrations play an important role in the normal physiologic adaptation to pregnancy. These effectors are reduced in patients with pregnancy hypertension, creating an opportunity to define the features of the renin–angiotensin–aldosterone system (RAAS) that are characteristic of this disorder. In the current study, we used a novel LC-MS/MS-based methodology to develop comprehensive profiles of RAAS peptides and effectors over gestation in a cohort of 74 pregnant women followed prospectively for the development of gestational hypertension and pre-eclampsia (HYP, 27 patients) versus those remaining normotensive (NT, 47 patients). In NT pregnancy, the plasma renin activity surrogate, (PRA-S, calculated from the sum of Angiotensin I + Angiotensin II) and aldosterone concentrations significantly increased from the first to the third trimester, accompanied by a modest increase in the concentrations of angiotensin peptide metabolites. In contrast, in HYP pregnancies, PRA-S and angiotensin peptides were largely unchanged over gestation, and third-trimester aldosterone concentrations were significantly lower compared with those in NT pregnancies. The results indicated that the predominant features of pregnancies that develop HYP are stalled or waning activation of the RAAS in the second half of pregnancy (accompanied by unchanging levels of angiotensin peptides) and the attenuated secretion of aldosterone.

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Section: Introductionmentioning

confidence: 99%

Activation of the Renin–Angiotensin–Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy

Shoemaker

Poglitsch²,

Hong

et al. 2023

IJMS

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“…High plasma renin activity was found to be an independent predictor of all-cause death in HFpEF patients, regardless of RAAS inhibitor treatment (HR = 2.14, 95% CI: 1.20-3.82, P = 0.010). High plasma renin activity may cause overactivation of RAAS and continuous negative effects on the cardiovascular and renal systems, leading to poor outcomes in HFpEF patients [ 42 ]. The abnormal increase of its final product, aldosterone, can cause water and sodium retention and increase blood pressure, increase cardiac preload, and further lead to left ventricular remodeling and dysfunction [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

Risk Prediction Models and Novel Prognostic Factors for Heart Failure with Preserved Ejection Fraction: A Systematic and Comprehensive Review

Lin,

Yang,

Liu

et al. 2023

CPD

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Background: Patients with heart failure with preserved ejection fraction (HFpEF) have large individual differences, unclear risk stratification, and imperfect treatment plans. Risk prediction models are helpful for the dynamic assessment of patients' prognostic risk and early intensive therapy of high-risk patients. The purpose of this study is to systematically summarize the existing risk prediction models and novel prognostic factors for HFpEF, to provide a reference for the construction of convenient and efficient HFpEF risk prediction models. Methods: Studies on risk prediction models and prognostic factors for HFpEF were systematically searched in relevant databases including PubMed and Embase. The retrieval time was from inception to February 1, 2023. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias in included studies. The predictive value of risk prediction models for end outcomes was evaluated by sensitivity, specificity, the area under the curve, C-statistic, C-index, etc. In the literature screening process, potential novel prognostic factors with high value were explored. Results: A total of 21 eligible HFpEF risk prediction models and 22 relevant studies were included. Except for 2 studies with a high risk of bias and 2 studies with a moderate risk of bias, other studies that proposed risk prediction models had a low risk of bias overall. Potential novel prognostic factors for HFpEF were classified and described in terms of demographic characteristics (age, sex, and race), lifestyle (physical activity, body mass index, weight change, and smoking history), laboratory tests (biomarkers), physical inspection (blood pressure, electrocardiogram, imaging examination), and comorbidities. Conclusion: It is of great significance to explore the potential novel prognostic factors of HFpEF and build a more convenient and efficient risk prediction model for improving the overall prognosis of patients. This review can provide a substantial reference for further research.

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“…The plasma renin activity surrogate (PRA-S) is the calculated sum of the equilibrium concentrations of angiotensins I and I ((eqAngiotensin I) + (eqAngiotensin II), pmol/L), and the AA2-R is the ratio of the concentrations of aldosterone to angiotensin II ((Aldosterone)/(eqAngiotensin II), (pmol/L)/(pmol/L)). These biomarkers are well-published in the literature as correlating with clinical characteristics and/or prediction outcomes in studies of hypertension [28,29], aldosteronism [26,27], heart failure [24,30], and more [31].…”

Section: Quantification Of Components Of the Raas: Angiotensin Peptid...mentioning

confidence: 99%

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension

Shoemaker,

Poglitsch,

Davis

et al. 2023

Biomedicines

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Emerging evidence indicates a previously unrecognized, clinically relevant spectrum of abnormal aldosterone secretion associated with hypertension severity. It is not known whether excess aldosterone secretion contributes to hypertension during pregnancy. We quantified aldosterone concentrations and angiotensin peptides in serum (using liquid chromatography with tandem mass spectrometry) in a cohort of 128 pregnant women recruited from a high-risk obstetrics clinic and followed prospectively for the development of gestational hypertension, pre-eclampsia, superimposed pre-eclampsia, chronic hypertension, or remaining normotensive. The cohort was grouped by quartile of aldosterone concentration in serum measured in the first trimester, and blood pressure, angiotensin peptides, and hypertension outcomes compared across the four quartiles. Blood pressures and body mass index were greatest in the top and bottom quartiles, with the top quartile having the highest blood pressure throughout pregnancy. Further stratification of the top quartile based on increasing (13 patients) or decreasing (19 patients) renin activity over gestation revealed that the latter group was characterized by the highest prevalence of chronic hypertension, use of anti-hypertensive agents, pre-term birth, and intrauterine growth restriction. Serum aldosterone concentrations greater than 704 pmol/L, the 75th percentile defined within the cohort, were evident across all categories of hypertension in pregnancy, including normotensive. These findings suggest that aldosterone excess may underlie the development of hypertension in pregnancy in a significant subpopulation of individuals.

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Renin Feedback Is an Independent Predictor of Outcome in HFpEF

Cited by 8 publications

References 32 publications

Activation of the Renin–Angiotensin–Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy

Activation of the Renin–Angiotensin–Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy

Risk Prediction Models and Novel Prognostic Factors for Heart Failure with Preserved Ejection Fraction: A Systematic and Comprehensive Review

Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension

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