(Circulation. 1995;92:3206-3211.)
© 1995 American Heart Association, Inc.
Articles |
Sympathetic Activation and Loss of Reflex Sympathetic Control in Mild Congestive Heart Failure
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 8-11, 1993, and published in Abstract form in Circulation (1993;88[suppl I]:I-572).
From the Cattedra di Medicina Interna, Ospedale S. Gerardo, Monza; the Istituto di Clinica Medica, Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore and Università di Milano; and Centro Auxologico Italiano, Milano, Italy.
Correspondence to Prof Giuseppe Mancia, Centro Fisiologia Clinica e Ipertensione, Policlinico, Via F Sforza 35, 20122 Milano, Italy.
Background Baroreflex control of sympathetic activity is impaired in severe congestive heart failure (CHF), probably causing the marked sympathetic activation typical of this condition. Little information exists, however, as to whether baroreflex impairment and related sympathetic activation also occur in mild CHF.
Methods and Results We studied 19 patients (age, 57.5±2.2 years, mean±SEM) with CHF in New York Heart Association (NYHA) class III or IV and with a marked reduction in left ventricular ejection fraction (LVEF, 30.1±1.5% from echocardiography) and 17 age-matched patients with CHF in NYHA class I or II and with an only slightly reduced LVEF (44.9±3.3%) that never was <40%. Seventeen age-matched healthy subjects served as control subjects. Primary measurements included beat-to-beat arterial blood pressure (with the Finapres technique), heart rate (from ECG), and postganglionic muscle sympathetic nerve activity (MSNA, from microneurography at the peroneal nerve). Measurements were performed at baseline and during baroreceptor stimulation (intravenous phenylephrine infusion), baroreceptor deactivation (intravenous nitroprusside infusion), and cold-pressor test. Baseline blood pressure was similar in the three groups, whereas heart rate was progressively greater from control subjects to patients with mild and severe CHF. MSNA (bursts per 100 heart beats) increased significantly and markedly from control subjects to patients with mild and severe CHF (47.1±2.9 versus 64.4±6.2 and 82.1±3.4, P<.05 and P<.01, respectively). Heart rate and MSNA were progressively reduced by phenylephrine infusion and progressively increased by nitroprusside infusion. Compared with control subjects, the responses were strikingly impaired in severe CHF patients, but a marked impairment also was seen in mild CHF patients. On average, baroreflex sensitivity in mild CHF patients was reduced by 59.1±5.5% (MSNA) and 64.8±4.8% (heart rate). In contrast, reflex responses to the cold-pressor test were similar in the three groups.
Conclusions These results demonstrate that in mild CHF patients the baroreceptor inhibitory influence on heart rate and MSNA is already markedly impaired. This impairment may be responsible for the early sympathetic activation that occurs in the course of CHF.
Key Words: heart failure • baroreceptors • reflex • nervous system
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G Tjeerdsma, M T Meinardi, W T A van der Graaf, M P van den Berg, N H Mulder, H J G M Crijns, E G E de Vries, and D J van Veldhuisen Early detection of anthracycline induced cardiotoxicity in asymptomatic patients with normal left ventricular systolic function: autonomic versus echocardiographic variables Heart, April 1, 1999; 81(4): 419 - 423. [Abstract] [Full Text]
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 G. S. Pepper and R. W. Lee Sympathetic Activation in Heart Failure and Its Treatment With {beta}-Blockade Arch Intern Med, February 8, 1999; 159(3): 225 - 234. [Abstract] [Full Text] [PDF]
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G. Grassi, D. Spaziani, G. Seravalle, G. Bertinieri, R. Dell'Oro, C. Cuspidi, and G. Mancia Effects of Amlodipine on Sympathetic Nerve Traffic and Baroreflex Control of Circulation in Heart Failure Hypertension, February 1, 1999; 33(2): 671 - 675. [Abstract] [Full Text] [PDF]
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G. Hasenfuss Animal models of human cardiovascular disease, heart failure and hypertrophy Cardiovasc Res, July 1, 1998; 39(1): 60 - 76. [Abstract] [Full Text] [PDF]
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B. P.M. Imholz, W. Wieling, G. A. van Montfrans, and K. H. Wesseling Fifteen years experience with finger arterial pressure monitoring:: assessment of the technology Cardiovasc Res, June 1, 1998; 38(3): 605 - 616. [Abstract] [Full Text] [PDF]
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G. Grassi, G. Seravalle, M. Colombo, G. Bolla, B. M. Cattaneo, F. Cavagnini, and G. Mancia Body Weight Reduction, Sympathetic Nerve Traffic, and Arterial Baroreflex in Obese Normotensive Humans Circulation, May 26, 1998; 97(20): 2037 - 2042. [Abstract] [Full Text] [PDF]
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D. H. Silber, G. Sutliff, Q. X. Yang, M. B. Smith, L. I. Sinoway, and U. A. Leuenberger Altered mechanisms of sympathetic activation during rhythmic forearm exercise in heart failure J Appl Physiol, May 1, 1998; 84(5): 1551 - 1559. [Abstract] [Full Text] [PDF]
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G. Grassi, M. Colombo, G. Seravalle, D. Spaziani, and G. Mancia Dissociation Between Muscle and Skin Sympathetic Nerve Activity in Essential Hypertension, Obesity, and Congestive Heart Failure Hypertension, January 1, 1998; 31(1): 64 - 67. [Abstract] [Full Text] [PDF]
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G. Grassi, B. M. Cattaneo, G. Seravalle, A. Lanfranchi, and G. Mancia Baroreflex Control of Sympathetic Nerve Activity in Essential and Secondary Hypertension Hypertension, January 1, 1998; 31(1): 68 - 72. [Abstract] [Full Text] [PDF]
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R. Willenbrock, H. Stauss, M. Scheuermann, K. J. Osterziel, T. Unger, and R. Dietz Effect of chronic volume overload on baroreflex control of heart rate and sympathetic nerve activity Am J Physiol Heart Circ Physiol, December 1, 1997; 273(6): H2580 - H2585. [Abstract] [Full Text] [PDF]
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K. Ashino, E. Gotoh, S.-i. Sumita, A. Moriya, and M. Ishii Percutaneous Transluminal Mitral Valvuloplasty Normalizes Baroreflex Sensitivity and Sympathetic Activity in Patients With Mitral Stenosis Circulation, November 18, 1997; 96(10): 3443 - 3449. [Abstract] [Full Text]
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P. Ponikowski, T. P. Chua, M. Piepoli, D. Ondusova, K. Webb-Peploe, D. Harrington, S. D. Anker, M. Volterrani, R. Colombo, G. Mazzuero, et al. Augmented Peripheral Chemosensitivity as a Potential Input to Baroreflex Impairment and Autonomic Imbalance in Chronic Heart Failure Circulation, October 21, 1997; 96(8): 2586 - 2594. [Abstract] [Full Text]
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H. R. Middlekauff, A. H. Nguyen, C. E. Negrao, E. U. Nitzsche, C. K. Hoh, B. A. Natterson, M. A. Hamilton, G. C. Fonarow, A. Hage, and J. D. Moriguchi Impact of Acute Mental Stress on Sympathetic Nerve Activity and Regional Blood Flow in Advanced Heart Failure : Implications for `Triggering' Adverse Cardiac Events Circulation, September 16, 1997; 96(6): 1835 - 1842. [Abstract] [Full Text]
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G. Grassi, B. M. Cattaneo, G. Seravalle, A. Lanfranchi, M. Pozzi, A. Morganti, S. Carugo, and G. Mancia Effects of Chronic ACE Inhibition on Sympathetic Nerve Traffic and Baroreflex Control of Circulation in Heart Failure Circulation, August 19, 1997; 96(4): 1173 - 1179. [Abstract] [Full Text]
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G. Grassi, B. M. Cattaneo, G. Seravalle, A. Lanfranchi, G. Bolla, and G. Mancia Baroreflex Impairment by Low Sodium Diet in Mild or Moderate Essential Hypertension Hypertension, March 1, 1997; 29(3): 802 - 807. [Abstract] [Full Text]
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S.-i. Ando, H. R. Dajani, B. L. Senn, G. E. Newton, and J. S. Floras Sympathetic Alternans: Evidence for Arterial Baroreflex Control of Muscle Sympathetic Nerve Activity in Congestive Heart Failure Circulation, January 21, 1997; 95(2): 316 - 319. [Abstract] [Full Text]
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B. Rundqvist, M. Elam, Y. Bergmann-Sverrisdottir, G. Eisenhofer, and P. Friberg Increased Cardiac Adrenergic Drive Precedes Generalized Sympathetic Activation in Human Heart Failure Circulation, January 7, 1997; 95(1): 169 - 175. [Abstract] [Full Text]
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G. E. Newton and J. D. Parker Cardiac Sympathetic Responses to Acute Vasodilation: Normal Ventricular Function Versus Congestive Heart Failure Circulation, December 15, 1996; 94(12): 3161 - 3167. [Abstract] [Full Text]
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