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Circulation, Vol 79, 51-58, Copyright © 1989 by American Heart Association
KA Ellenbogen, PK Mohanty, S Szentpetery and MD Thames
Arterial baroreflex control of the heart and peripheral circulation is
markedly impaired in humans and animals with congestive heart failure.
After reversal of heart failure in animal models, arterial baroreflex
control of heart rate remains impaired for up to 8 months. Cardiac
transplantation restores normal ventricular function and completely
reverses heart failure, but does it normalize arterial baroreflex control
of heart rate in humans? We studied baroreflex sensitivity in 11 patients
with severe heart failure, six normal control patients, and 23 patients at
2 weeks to 4 years after orthotopic cardiac transplantation. Baroreflex
sensitivity was assessed with intravenous bolus injections of phenylephrine
and is expressed as change in RR or PP interval (msec) per millimeters of
mercury rise in systolic arterial pressure. Atrial rate of both donor
(denervated) and recipient (innervated) atria were measured in the
transplant group. Baroreflex sensitivity in patients with severe heart
failure was 2.0 +/- 0.3 msec/mm Hg, but in patients after cardiac
transplantation, it was 13.0 +/- 0.9 msec/mm Hg (p less than 0.001). The
responses in the transplant group were similar to those observed in normal
controls (10 +/- 1.2 msec/mm Hg, p = NS). Our data indicate that patients
with severe congestive heart failure have marked abnormalities of
baroreflex control, which are reversed as early as 2 weeks after cardiac
transplantation. In view of this rapid reversal, we consider it unlikely
that abnormal baroreflex sensitivity seen in heart failure is due to
structural alterations in the baroreceptors. We speculate that neurohumoral
rather than structural abnormalities account for depressed baroreflex
sensitivity in heart failure.
ARTICLES
Arterial baroreflex abnormalities in heart failure. Reversal after orthotopic cardiac transplantation
Department of Medicine, Medical College of Virginia, McGuire Veterans Administration Medical Center, Richmond 23249.
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