Circulation, Vol 73, 615-621, Copyright © 1986 by American Heart Association
GJ Hasking, MD Esler, GL Jennings, D Burton, JA Johns and PI Korner
The analysis of plasma kinetics of the sympathetic neurotransmitter
norepinephrine can be used to estimate sympathetic nervous "activity"
(integrated nerve firing rate) for the body as a whole and for individual
organs. In 12 patients with cardiac failure (left ventricular ejection
fraction 10% to 39%), the mean arterial plasma norepinephrine concentration
was 557 +/- 68 pg/ml (mean +/- SE) compared with 211 +/- 21 pg/ml in 15
subjects without heart failure (p less than .002). The difference was due
to both increased release of norepinephrine to plasma (indicating increased
"total" sympathetic activity) and reduced clearance of norepinephrine from
plasma. The increase in sympathetic activity did not involve all organs
equally. Cardiac (32 +/- 9 vs 5 +/- 1 ng/min; p less than .002) and renal
(202 +/- 45 vs 66 +/- 9 ng/min; p = .002) norepinephrine spillover were
increased by 540% and 206%, respectively, but norepinephrine spillover from
the lungs was normal. Adrenomedullary activity was also increased in the
patients with heart failure, whose mean arterial plasma epinephrine
concentration was 181 +/- 38 pg/ml compared with 71 +/- 12 pg/ml in control
subjects (p less than .02). There is marked regional variation, inapparent
from measurements of plasma norepinephrine concentration, in sympathetic
nerve activity in patients with congestive heart failure. The finding of
increased cardiorenal norepinephrine spillover has important
pathophysiologic and therapeutic implications.
ARTICLES
Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity
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