Survival in
congestive heart failure is related to plasma
catecholamines and
atrial natriuretic peptide at rest, but the prognostic importance of changes during exercise is unknown. The aim of this study was to evaluate the prognostic value of
catecholamines and
atrial natriuretic peptide at rest and during maximal exercise in
congestive heart failure, and to compare it to clinical and exercise test variables and left ventricular ejection fraction. One hundred ninety consecutive patients (136 men and 54 women; median age, 66 years; range, 42-75 years) with clinically stable
congestive heart failure were included. Sixteen patients were in New York Heart Association class I, 87 in class II, 83 in class III, and 4 in class IV. Left ventricular ejection fraction was 0.30 (range, 0.06-0.74). Total survival after 1 year was 79%, after 2 years, it was 68%. Prognostic variables at univariate analysis were: plasma
noradrenaline at rest (P < .0001), plasma
adrenaline at rest (P = .049), and
atrial natriuretic peptide at rest (P = .016). During exercise, plasma
catecholamines and plasma
atrial natriuretic peptide increased significantly; the change, however, was not related to survival. Six variables carried significant, independent prognostic information in a multivariate analysis: left ventricular ejection fraction (P = .03), plasma
noradrenaline at rest (P = .009), New York Heart Association class III + IV (P = .005), increase in heart rate during exercise < or = 35 min-1 (P < .0001), serum
creatinine > 121 mumol/L (P = .004), and serum
urea > 7.6 mmol/L (P = .007). Patients with
congestive heart failure have a poor survival despite intensive medical treatment. Plasma
catecholamines and plasma
atrial natriuretic peptide are elevated at rest and rises further during exercise; the increase, however, is not related to mortality. Plasma
noradrenaline at rest contributes with further prognostic information despite knowledge of clinical and exercise variables and was the only neurohormonal variable with independent, significant prognostic information on survival.