Objectives Previously, we reported that autoantibodies specific for the angiotensin II type 1 receptor (anti-AT1-AR) is implicated in the pathogenesis of congestive heart failure (CHF). We hypothesised that the presence of anti-AT1-AR is associated with the left ventricular function of CHF patients in response to perindopril.
Methods Synthetic angiotensin II type 1 receptor (AT1-R) peptides were used as the target antigen. An ELISA was used to screen the sera of 156 CHF patients with NYHA class II-IV. The patients were then divided into positive or negative groups based on their anti-AT1-AR reactivity. Each patient of each group was subjected to an echocardiography and a 6-minute walk test. Performance at baseline and after one year of perindopril therapy with β-receptor blockers, diuretics, and digoxin were documented.
Results A total of 138 patients completed the final analysis in this study, including 82 patients with (+) anti-AT1-AR and 56 patients with (–) anti-AT1-AR. Compared to the patients with (–) anti-AT1-AR, patients with (+) anti-AT1-AR had a greater improvement in left ventricular end-diastolic, end-systolic dimensions, and ejection fraction (all P < 0.05). Similar trends were also observed in patients subjected to a 6-minute walk test (P < 0.05) after one year of perindopril therapy in combination with standard treatment. CHF patients that were (+) anti-AT1-AR responded better to target perindopril dose than those that were (–) anti-AT1-AR (P < 0.01). After 5 years of follow-up, there was no significant difference for hospitalisation, death, or cardiovascular failures between patients with (+) anti-AT1-AR and (–) anti-AT1-AR.
Conclusions Compared to (–) anti-AT1-AR, patients that were (+) anti-AT1-AR had a greater clinical therapeutic benefit on left ventricluar remodeling and function. This result potentially presents a novel biomarker of the renin-angiotensin-aldosterone system for assess of the level of receptor activation, as well as therapeutic intervention in patients with heart failure.