Aldosterone dysregulation predicts the risk of mortality and rehospitalization in heart failure with a preserved ejection fraction

Serum aldosterone is associated with cardiac remodeling, which contributes to morbidity and mortality in heart failure(HF);however, the prognostic value of aldosterone in HF with a preserved ejection fraction(HFpEF) is unclear. We used liquid chromatography-tandem mass spectrometry to quantify serum aldosterone in 873 patients with HFpEF in a Registry Study of Biomarkers for HF. The retrospective study was conducted at Beijing Anzhen Hospital from May 2017 to October 2019. The primary endpoint was a composite of all-cause mortality and rehospitalization for HF. Aldosterone concentrations in patients with and without events were 124.22 pmol L-1(interquartile range(IQR): 48.62–256.20) and 96.33 pmol L-1(IQR: 37.33–215.76), respectively(P=0.023). Aldosterone independently predicted all-cause mortality(adjusted hazard ratio(aHR), 1.55;95% confidence interval(95%CI), 1.06–2.27; P=0.024) and the primary endpoint(a HR, 1.43; 95%CI, 1.11–1.85; P=0.006).Patients with high aldosterone concentrations were at higher risk of concentric remodeling(adjusted odds ratio(aOR), 1.45; 95%CI, 1.03–2.04; P=0.034). Patients with high aldosterone and B-type natriuretic peptide concentrations were at a higher risk of the primary endpoint(hazard ratio(HR), 1.85; 95%CI, 1.29–2.66; P=0.001). We conclude that elevated aldosterone is associated with a risk of rehospitalization with HF and all-cause mortality in patients with HFpEF.