PMID- 7586305
OWN - NLM
STAT- MEDLINE
DCOM- 19951228
LR  - 20220321
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 92
IP  - 11
DP  - 1995 Dec 1
TI  - Sympathetic activation and loss of reflex sympathetic control in mild congestive 
      heart failure.
PG  - 3206-11
AB  - 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 inhibitor 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.
FAU - Grassi, G
AU  - Grassi G
AD  - Cattedra di Medicina Interna, Ospedale S. Gerardo, Monza, Milano, Italy.
FAU - Seravalle, G
AU  - Seravalle G
FAU - Cattaneo, B M
AU  - Cattaneo BM
FAU - Lanfranchi, A
AU  - Lanfranchi A
FAU - Vailati, S
AU  - Vailati S
FAU - Giannattasio, C
AU  - Giannattasio C
FAU - Del Bo, A
AU  - Del Bo A
FAU - Sala, C
AU  - Sala C
FAU - Bolla, G B
AU  - Bolla GB
FAU - Pozzi, M
AU  - Pozzi M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Vasoconstrictor Agents)
RN  - 0 (Vasodilator Agents)
RN  - 169D1260KM (Nitroprusside)
RN  - 1WS297W6MV (Phenylephrine)
RN  - X4W3ENH1CV (Norepinephrine)
SB  - IM
CIN - Circulation. 1996 Nov 1;94(9):2310-1. PMID: 8901694
MH  - Adult
MH  - Aged
MH  - Baroreflex/*physiology
MH  - Blood Pressure/physiology
MH  - Case-Control Studies
MH  - Cold Temperature
MH  - Female
MH  - Heart Failure/diagnosis/*physiopathology
MH  - Heart Rate/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nitroprusside
MH  - Norepinephrine/blood
MH  - Phenylephrine
MH  - Pressoreceptors/drug effects/*physiopathology
MH  - Sympathetic Nervous System/*physiopathology
MH  - Vasoconstrictor Agents
MH  - Vasodilator Agents
EDAT- 1995/12/01 00:00
MHDA- 1995/12/01 00:01
CRDT- 1995/12/01 00:00
PHST- 1995/12/01 00:00 [pubmed]
PHST- 1995/12/01 00:01 [medline]
PHST- 1995/12/01 00:00 [entrez]
AID - 10.1161/01.cir.92.11.3206 [doi]
PST - ppublish
SO  - Circulation. 1995 Dec 1;92(11):3206-11. doi: 10.1161/01.cir.92.11.3206.