Objectives—We sought to determine whether circulating soluble angiotensin-converting
enzyme 2 (sACE2) is increased in the plasma of patients with heart failure (HF).
Background—Angiotensin-converting enzyme 2 (ACE2) is an integral membrane protein that
antagonizes the actions of angiotensin II and prevents the development of HF in animal models.
However, because of the need for invasive cardiac tissue sampling, little is known about whether
ACE2 is involved in the pathophysiology of HF in humans.
Methods—We developed a sensitive and specific assay to measure sACE2 activity in human
plasma and screened a heterogeneous group of patients suspected of having clinical HF.
Results—Increasing sACE2 plasma activity strongly correlated with a clinical diagnosis of HF
(p = 0.0002), worsening left ventricular ejection fraction (p < 0.0001), and increasing B-type
natriuretic peptide levels (p < 0.0001). Similar to B-type natriuretic peptide, sACE2 activity
reflected the severity of HF, with increasing levels associated with worsening New York Heart
Association functional class (p < 0.0001). These associations were independent of other disease
states and medication use. We found that sACE2 activity was increased in patients with both
ischemic and nonischemic cardiomyopathies and also in patients with clinical HF but a preserved
left ventricular ejection fraction.
Conclusions—Soluble ACE2 activity is increased in patients with HF and correlates with
disease severity, suggesti