Relationship Between Urinary Angiotensinogen and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

BACKGROUND: Activation of the renin–angiotensin–aldosterone system has an important role in the pathophysiology of heart failure with reduced ejection fraction. While the effects of systemic renin–angiotensin–aldosterone system activation on heart failure with reduced ejection fraction are well known, the impact of the local renin–angiotensin–aldosterone system on heart failure with reduced ejection fraction is not fully understood because of limited clinical research. This study aimed to investigate the effect of urinary angiotensinogen level, an accepted indicator of local renin–angiotensin–aldosterone system activation, on all-cause mortality in patients with heart failure with reduced ejection fraction. METHODS: This retrospective, single-center study included 60 patients with baseline urinary angiotensinogen data and survival/mortality data at 4 years. Urinary angiotensinogen values were standardized to the urinary creatinine value measured from the same urine sample. The median urinary angiotensinogen/urinary creatinine value among all patients (114 µg/g) was used as a cutoff to divide the patients into 2 groups. Mortality data were obtained from the national registry systems or by telephone. RESULTS: Comparison of all-cause mortality in the 2 groups showed that 22 deaths (71%) occurred in the group with a urinary angiotensinogen/urinary creatinine ratio above the median and 10 deaths (35.5%) occurred in the group of patients with urinary angiotensinogen/urinary creatinine equal to or below the median value (P = .005). CONCLUSION: Our study suggests that urinary angiotensinogen can be used as a new biomarker in the prognosis and follow-up of heart failure patients.