Reducing cardiac filling pressure lowers norepinephrine spillover in patients with chronic heart failure

Article

关键词: DIASTOLIC VENTRICULAR INTERACTION;    SYMPATHETIC NERVOUS ACTIVITY;    BODY NEGATIVE-PRESSURE;    FAILING HUMAN HEART;    VASCULAR-RESPONSES;    BAROREFLEX;    REFLEX;    ACTIVATION;    BARORECEPTORS;    RECORDINGS;   

DOI  :  10.1161/01.CIR.101.17.2053

来源: SCIE

【 摘 要 】

Background-We studied the cardiac sympathetic response to selective unloading of cardiopulmonary baroreceptors in subjects with normal left ventricular (LV) function and congestive heart failure (CHF). Methods and Results-Eight patients with normal LV function (age 57+/-5 years, ejection fraction 58+/-2%) and 8 patients with CHF (age 60+/-2 years; ejection fraction 19+/-2%) were studied. Instrumentation consisted of an arterial line, a pulmonary artery catheter, and a coronary sinus thermodilution catheter. The radiotracer technique was used for measurement of cardiac norepinephrine spillover (CANESP) and total-body norepinephrine spillover. Lower-body negative pressure (LBNP) was applied at 2 levels: nonhypotensive and hypotensive LBNP. Nonhypotensive LBNP reduced filling pressures significantly in both groups. Arterial pressure did not change. This reduction in filling pressures caused a significant reduction in CANESP in the CHF group (from 167+/-53 to 125+/-37 pmol/min, P<0.05) but no change in the normal LV function group. Hypotensive LBNP caused a significant increase in CANESP in the normal group (73+/-13 vs 122+/-27 pmol/min, P<0.05) but no significant change in those with CHF. Conclusions-We conclude that selective reduction in filling pressures lowers cardiac norepinephrine spillover in patients with CHF. These findings suggest that a goal of CHF management should be to reduce cardiac filling pressures while avoiding systemic hypotension.

【 授权许可】

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