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.