Circulation, Vol 88, 1620-1627, Copyright © 1993 by American Heart Association
M Volpe, C Tritto, N DeLuca, S Rubattu, MA Rao, F Lamenza, A Mirante, I Enea, V Rendina and AF Mele
BACKGROUND. Sodium retention and hormonal activation are fundamental
hallmarks in congestive heart failure. The present study was designed to
assess the ability of patients with asymptomatic to mildly symptomatic
heart failure and no signs or symptoms of congestion to excrete ingested
sodium and to identify possible early abnormalities of hormonal and
hemodynamic mechanisms related to sodium handling. METHODS AND RESULTS. The
effects of a high salt diet (250 mEq/day for 6 days) on hemodynamics,
salt-regulating hormones, and renal excretory response were investigated in
a balanced study in 12 untreated patients with idiopathic or ischemic
dilated cardiomyopathy and mild heart failure (NYHA class I-II, ejection
fraction < 50%) (HF) and in 12 normal subjects, who had been previously
maintained a 100 mEq/day NaCl diet. In normal subjects, high salt diet was
associated with significant increases of echocardiographically measured
left ventricular end- diastolic volume, ejection fraction, and stroke
volume (all P < .001) and with a reduction of total peripheral
resistance (P < .001). In addition, plasma atrial natriuretic factor
(ANF) levels increased (P < .05), and plasma renin activity and
aldosterone concentrations fell (both P < .001) in normals in response
to salt excess. In HF patients, both left ventricular end-diastolic and
end-systolic volumes increased in response to high salt diet, whereas
ejection fraction and stroke volume failed to increase, and total
peripheral resistance did not change during high salt diet. In addition,
plasma ANF levels did not rise in HF in response to salt loading, whereas
plasma renin activity and aldosterone concentrations were as much
suppressed as in normals. Although urinary sodium excretions were not
significantly different in the two groups, there was a small but systematic
reduction of daily sodium excretion in HF, which resulted in a
significantly higher cumulative sodium balance in HF than in normals during
the high salt diet period (P < .001). CONCLUSIONS. These results show a
reduced ability to excrete a sodium load and early abnormalities of cardiac
and hemodynamic adaptations to salt excess in patients with mild heart
failure and no signs or symptoms of congestion.
ARTICLES
Abnormalities of sodium handling and of cardiovascular adaptations during high salt diet in patients with mild heart failure
First Clinica Medica, Facolta di Medicina e Chirurgia, Universita di Napoli Federico II, Italy.
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