PMID- 15492308
OWN - NLM
STAT- MEDLINE
DCOM- 20050512
LR  - 20071115
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 110
IP  - 17
DP  - 2004 Oct 26
TI  - Abnormalities of neurohormonal and cardiac autonomic nervous activities relate 
      poorly to functional status in fontan patients.
PG  - 2601-8
AB  - BACKGROUND: Impaired cardiac autonomic nervous activities and increased 
      neurohumoral activities (CANA, NHA) characterize Fontan patients. However, the 
      clinical significance of these changes is not clearly understood. Our purpose was 
      to clarify the clinical significance of the CANA and NHA in stable Fontan 
      patients. METHODS AND RESULTS: We divided 22 atriopulmonary connection (APC) and 
      75 total cavopulmonary connection (TCPC) patients into 4 subgroups according to 
      New York Heart Association (NYHA) class (1.8+/-0.6) and measured various CANA and 
      NHA indices. All NHA indices were elevated in the symptomatic patients (P<0.001). 
      Natriuretic peptides were higher in the APC than in the TCPC patients, and the 
      hemodynamics showed no correlation with brain natriuretic peptide in the APC 
      patients. Low arterial oxygen saturation and impaired hemodynamics greatly 
      influenced all elevated NHA indices (P<0.01), except for plasma renin activity, 
      in the TCPC patients. Impaired CANA indices did not relate to NYHA class, 
      although surgeries were associated with lower heart rate variability. In addition 
      to poor correlation between NHA and CANA, age and ventricular morphology had no 
      impact on all CANA and NHA indices, except for high norepinephrine in right 
      ventricular Fontan patients. CONCLUSIONS: Although symptomatic Fontan patients 
      exhibit higher NHA, CANA is not related to either NYHA class or NHA. APC itself 
      is responsible for higher natriuretic peptides, and arterial oxygen desaturation 
      has a great impact on elevated NHA in the TCPC patients. These characteristics of 
      the NHA and CANA differ from those of heart failure patients with biventricular 
      physiology.
FAU - Ohuchi, Hideo
AU  - Ohuchi H
AD  - Department of Pediatrics, National Cardiovascular Center, Osaka, Japan. 
      ouchi.hideo@mayo.edu
FAU - Takasugi, Hisashi
AU  - Takasugi H
FAU - Ohashi, Hiroyuki
AU  - Ohashi H
FAU - Yamada, Osamu
AU  - Yamada O
FAU - Watanabe, Ken
AU  - Watanabe K
FAU - Yagihara, Toshikatsu
AU  - Yagihara T
FAU - Echigo, Shigeyuki
AU  - Echigo S
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Controlled Clinical Trial
PT  - Journal Article
DEP - 20041018
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Neurotransmitter Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Autonomic Nervous System/*physiopathology
MH  - Child
MH  - Child, Preschool
MH  - Exercise Test
MH  - Female
MH  - *Fontan Procedure
MH  - Heart/*innervation/physiopathology
MH  - Heart Defects, Congenital/classification/diagnosis
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Neurotransmitter Agents/*blood
MH  - Vital Capacity
EDAT- 2004/10/20 09:00
MHDA- 2005/05/13 09:00
CRDT- 2004/10/20 09:00
PHST- 2004/10/20 09:00 [pubmed]
PHST- 2005/05/13 09:00 [medline]
PHST- 2004/10/20 09:00 [entrez]
AID - 01.CIR.0000145545.83564.51 [pii]
AID - 10.1161/01.CIR.0000145545.83564.51 [doi]
PST - ppublish
SO  - Circulation. 2004 Oct 26;110(17):2601-8. doi: 10.1161/01.CIR.0000145545.83564.51. 
      Epub 2004 Oct 18.