Objective To investigate the stratification risk of catecholamines-β-adrenoceptor （β-AR）-cAMP pathway for cardiogenic death events in patients with congestive heart failure （CHF）. Methods A total of 83 identified CHF patients with a baseline and follow-up plasma levels of norepinephrine （NE） and epinephrine （E）

lymphocytes β-AR density （Bmax）

and intralymphocyte cAMP content in peripheral blood were followed up. Major cardiogenic death events were registered. Results The period between the initial entry and the last follow-up measurement were 51±16 months

the total duration of clinical follow-up after the last measurement were 14±8 months. During follow-up

39 patients died of cardiogenic （sudden death 17 patients

worsening heart failure 22 patients）. Persistence of high NE

E

and cAMP from baseline to follow-up were confirmed as risk predicting factors of cardiovascular events. Persistence NE above 4.0 nmol/L

E above 3.5 nmol/L

and the intralymphocyte cAMP content above 3.5 pmd·mg-1·pro-1 from baseline to follow-up were significant adverse prognostic predictors. The major cardiogenic death events rates per 100 patients-years were 1.33 and 4.82 in patients with NE below and above 4.0 nmol/L （HR: 2.91; 95% CI: 1.08-7.33; P = 0.015）; were 1.42 and 4.36 in the patients with E levels below and above 3.5 nmol/L （HR: 2.64; 95% CI: 1.02-6.41; P = 0.019）; were 1.81 and 4.67 in the patients with the intralymphocyte cAMP content below and above 3.5 pmd·mg-1·pro-1 （HR: 2.79; 95% CI: 1.04-6.83; P = 0.017）

but difference was not significant between the β-AR density below and above median. Conclusions Persistent increase in circulating catecholamines and intralymphocyte cAMP content may increase the long-term mortality in CHF patients.