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Heusser K, Wittkoepper J, Bara C, Haverich A, Diedrich A, Levine BD, Schmitto JD, Jordan J, Tank J. Sympathetic vasoconstrictor activity before and after left ventricular assist device implantation in patients with end-stage heart failure. Eur J Heart Fail 2021; 23:1955-1959. [PMID: 34496114 DOI: 10.1002/ejhf.2344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Sympathetic overactivity, which predicts poor outcome in patients with heart failure, normalizes following cardiac transplantation. We tested the hypothesis that haemodynamic improvement following left ventricular assist device (LVAD) implantation is also associated with reductions in centrally generated sympathetic activity. METHODS AND RESULTS In eight patients with heart failure (two women, six men, age 44-66 years), we continuously recorded electrocardiogram, beat-to-beat finger blood pressure, respiration, and muscle sympathetic nerve activity (MSNA) before and after implantation of the continuous-flow LVAD devices HeartWare HVAD (n = 4) and HeartMate II (n = 2), and the non-continuous-flow device HeartMate 3 (n = 2). LVAD implantation increased cardiac output by 1.29 ± 0.88 L/min (P = 0.060) and mean arterial pressure by 16.2 ± 7.9 mmHg (P < 0.001), while reducing pulse pressure by 25.3 ± 9.8 mmHg (P < 0.001). LVAD implantation did not change MSNA burst frequency (-1.3 ± 7.5 bursts/min, P = 0.636), total activity (+0.62 ± 1.83 au, P = 0.369), or normalized activity (+0.63 ± 4.23, P = 0.685). MSNA burst incidence was decreased (-7.8 ± 9.3 bursts/100 heart beats, P = 0.049). However, cardiac ectopy altered MSNA bursting patterns that could be mistaken for sympatholysis. CONCLUSION Implantation of current design LVAD does not consistently normalize sympathetic activity in patients with end-stage heart failure despite haemodynamic improvement.
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Affiliation(s)
- Karsten Heusser
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Judith Wittkoepper
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - André Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University Medical Center & Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Chair of Aerospace Medicine, University of Cologne, Cologne, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
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Sympathetic neural overdrive in congestive heart failure and its correlates: systematic reviews and meta-analysis. J Hypertens 2020; 37:1746-1756. [PMID: 30950979 DOI: 10.1097/hjh.0000000000002093] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Sympathetic neural activation occurs in congestive heart failure (CHF). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities as well as confounders (including treatment) represented major weaknesses not allowing to identify the major features of the phoenomenon, particularly in mild CHF. This meta-analysis evaluated 2530 heart failure (CHF) patients recruited in 106 microneurographic studies. It was based on muscle sympathetic nerve activity (MSNA) quantification in CHF of different clinical severity, but data from less widely addressed conditions, such as ischemic vs. idiopathic, were also considered. METHODS Assessment was extended to the relationships of MSNA with venous plasma norepinephrine, heart rate (HR) and echocardiographic parameters of cardiac morphology [left ventricular (LV) end-diastolic diameter] and function (LV ejection fraction) as well. RESULTS MSNA was significantly greater (1.9 times, P < 0.001) in CHF patients as compared with healthy controls, a progressive significant increase being observed from New York Heart Association classes I-IV in unadjusted and adjusted analyses. MSNA was significantly greater in both untreated and treated CHF (P < 0.001 for both), related to left ventricular (LV) end-diastolic diameter and to a lesser extent to LV ejection fraction (r = 0.24 and -0.05, P < 0.001 and <0.01, respectively), and closely associated with HR (r = 0.66, P < 0.001) and plasma norepinephrine (r = 0.68, P < 0.001). CONCLUSION CHF is characterized by sympathetic overactivity which mirrors the degree of LV dysfunction independently of the stage of CHF, its cause and presence of confounders or pharmacological treatment. plasma norepinephrine and HR represent potentially valuable surrogate markers of sympathetic activation in the clinical setting.
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Abstract
The pathophysiology of heart failure (HF) is characterized by hemodynamic abnormalities that result in neurohormonal activation and autonomic imbalance with increase in sympathetic activity and withdrawal of vagal activity. Alterations in receptor activation from this autonomic imbalance may have profound effects on cardiac function and structure. Inhibition of the sympathetic drive to the heart through β-receptor blockade has become a standard component of therapy for HF with a dilated left ventricle because of its effectiveness in inhibiting the ventricular structural remodeling process and in prolonging life. Several devices for selective modulation of sympathetic and vagal activity have recently been developed in an attempt to alter the natural history of HF. The optimal counteraction of the excessive sympathetic activity is still unclear. A profound decrease in adrenergic support with excessive blockade of the sympathetic nervous system may result in adverse outcomes in clinical HF. In this review, we analyze the data supporting a contributory role of the autonomic functional alterations on the course of HF, the techniques used to assess autonomic nervous system activity, the evidence for clinical effectiveness of pharmacological and device interventions, and the potential future role of autonomic nervous system modifiers in the management of this syndrome.
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Affiliation(s)
- Viorel G Florea
- From the Minneapolis VA Health Care System, Section of Cardiology (V.G.F.) and Rasmussen Center for Cardiovascular Disease Prevention, Department of Medicine (J.N.C.), University of Minnesota Medical School
| | - Jay N Cohn
- From the Minneapolis VA Health Care System, Section of Cardiology (V.G.F.) and Rasmussen Center for Cardiovascular Disease Prevention, Department of Medicine (J.N.C.), University of Minnesota Medical School.
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Labrunée M, Despas F, Marque P, Guiraud T, Galinier M, Senard JM, Pathak A. Acute electromyostimulation decreases muscle sympathetic nerve activity in patients with advanced chronic heart failure (EMSICA Study). PLoS One 2013; 8:e79438. [PMID: 24265770 PMCID: PMC3827140 DOI: 10.1371/journal.pone.0079438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 09/23/2013] [Indexed: 11/25/2022] Open
Abstract
Background Muscle passive contraction of lower limb by neuromuscular electrostimulation (NMES) is frequently used in chronic heart failure (CHF) patients but no data are available concerning its action on sympathetic activity. However, Transcutaneous Electrical Nerve Stimulation (TENS) is able to improve baroreflex in CHF. The primary aim of the present study was to investigate the acute effect of TENS and NMES compared to Sham stimulation on sympathetic overactivity as assessed by Muscle Sympathetic Nerve Activity (MSNA). Methods We performed a serie of two parallel, randomized, double blinded and sham controlled protocols in twenty-two CHF patients in New York Heart Association (NYHA) Class III. Half of them performed stimulation by TENS, and the others tested NMES. Results Compare to Sham stimulation, both TENS and NMES are able to reduce MSNA (63.5 ± 3.5 vs 69.7 ± 3.1 bursts / min, p < 0.01 after TENS and 51.6 ± 3.3 vs 56.7 ± 3.3 bursts / min, p < 0, 01 after NMES). No variation of blood pressure, heart rate or respiratory parameters was observed after stimulation. Conclusion The results suggest that sensory stimulation of lower limbs by electrical device, either TENS or NMES, could inhibit sympathetic outflow directed to legs in CHF patients. These properties could benefits CHF patients and pave the way for a new non-pharmacological approach of CHF.
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Affiliation(s)
- Marc Labrunée
- National Institute of Health and Medical ResearchTeam Institut des maladies métaboliques et cardiovasculaires, Toulouse, France
- Faculty of Medicine, University of Toulouse III Paul Sabatier F-31432, Toulouse, France
- Federation of Cardiology, Universitary Hospital of Toulouse, F-31073, Toulouse, France
- Physical Medicine and Rehabilitation unit, Universitary Hospital of Toulouse, F-31073, Toulouse, France
- * E-mail:
| | - Fabien Despas
- National Institute of Health and Medical ResearchTeam Institut des maladies métaboliques et cardiovasculaires, Toulouse, France
- Faculty of Medicine, University of Toulouse III Paul Sabatier F-31432, Toulouse, France
- Clinical Pharmacology unit, Universitary Hospital of Toulouse, F-31073, Toulouse, France
| | - Philippe Marque
- Faculty of Medicine, University of Toulouse III Paul Sabatier F-31432, Toulouse, France
- Physical Medicine and Rehabilitation unit, Universitary Hospital of Toulouse, F-31073, Toulouse, France
| | - Thibaut Guiraud
- National Institute of Health and Medical ResearchTeam Institut des maladies métaboliques et cardiovasculaires, Toulouse, France
- Cardiopulmonary rehabilitation center, Saint-Orens de Gameville, France
| | - Michel Galinier
- Faculty of Medicine, University of Toulouse III Paul Sabatier F-31432, Toulouse, France
- Federation of Cardiology, Universitary Hospital of Toulouse, F-31073, Toulouse, France
| | - Jean Michel Senard
- National Institute of Health and Medical ResearchTeam Institut des maladies métaboliques et cardiovasculaires, Toulouse, France
- Faculty of Medicine, University of Toulouse III Paul Sabatier F-31432, Toulouse, France
- Clinical Pharmacology unit, Universitary Hospital of Toulouse, F-31073, Toulouse, France
| | - Atul Pathak
- National Institute of Health and Medical ResearchTeam Institut des maladies métaboliques et cardiovasculaires, Toulouse, France
- Faculty of Medicine, University of Toulouse III Paul Sabatier F-31432, Toulouse, France
- Federation of Cardiology, Universitary Hospital of Toulouse, F-31073, Toulouse, France
- Clinical Pharmacology unit, Universitary Hospital of Toulouse, F-31073, Toulouse, France
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Turitto G, El-Sherif N. Cardiac Resynchronization Therapy: A Review of Proarrhythmic and Antiarrhythmic Mechanisms. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:115-22. [PMID: 17241325 DOI: 10.1111/j.1540-8159.2007.00585.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Available evidence supports the hypothesis that cardiac resynchronization therapy (CRT) results in favorable structural as well as electrical remodeling. Electrical remodeling seems to be related, to a large extent, to structural remodeling, usually referred to as reverse remodeling of left ventricular (LV) dysfunction. This can lead to amelioration of the arrhythmogenic substrate associated with depressed LV systolic function and heart failure. However, a direct electrophysiological effect due to favorable remodeling of repolarization with reduction of the dispersion of repolarization cannot be ruled out. On the other hand, in a small subgroup of patients, CRT could increase the dispersion of repolarization and induce malignant ventricular tachyarrhythmias. Clinical trials have consistently shown improved outcome with CRT-defibrillators (CRT-D) and more trials have demonstrated the benefits of the defibrillator in the population with depressed LV function. However, some physicians argue that implanting the less expensive and less complicated CRT-pacemaker (CRT-P) may be appropriate in certain groups of patients. Before this position is accepted, it is imperative that criteria for the selection of this group of patients with presumably low risk for sudden arrhythmic death as well as the proarrhythmic effect of CRT be clearly defined.
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Affiliation(s)
- Gioia Turitto
- Cardiac Electrophysiology, New York Methodist Hospital, New York 11215, USA.
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Najem B, Unger P, Preumont N, Jansens JL, Houssière A, Pathak A, Xhaet O, Gabriel L, Friart A, De Roy L, Vandenbossche JL, van de Borne P. Sympathetic control after cardiac resynchronization therapy: responders versus nonresponders. Am J Physiol Heart Circ Physiol 2006; 291:H2647-52. [PMID: 16844919 DOI: 10.1152/ajpheart.00373.2006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac resynchronization therapy (CRT) decreases muscle sympathetic nerve activity (MSNA) in patients with severe congestive heart failure (CHF) and cardiac asynchrony. Whether this affects equally patients who clinically respond or not to CRT is unknown. We tested the hypothesis that the favorable effects of CRT on MSNA disappear on CRT interruption only in those who respond to CRT. Twenty-three consecutive CHF patients participated in the study, among whom 16 presented a symptomatic improvement by one or more New York Heart Association (NYHA) functional classes 15 ± 5 mo after CRT (responders), and seven had not improved after 12 ± 4 mo of CRT (nonresponders). MSNA and echocardiographic recordings were obtained in random order during atrio-right ventricular pacing (ARV), without stimulation in patients who were not pacemaker dependent (OFF, n = 17), and during atrio-biventricular pacing (BIV). Responders had a longer 6-min walking distance, a lower NYHA class and brain natriuretic peptide levels, and a better quality of life than did nonresponders (all P < 0.05). MSNA increased by 25 ± 7% in the responders, whereas it remained unchanged in the nonresponders, when shifting from the BIV mode to a nonsynchronous condition (ARV and OFF modes) ( P < 0.01). Cardiac output decreased by 0.7 ± 0.2 l/min in the responders but did not change when shifting from the BIV mode to the nonsynchronous pacing mode in the nonresponders ( P < 0.01). In conclusion, reversible sympathoinhibition is a marker of the clinical response to CRT.
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Affiliation(s)
- Boutaïna Najem
- Dept. of Cardiology, Erasme Hospital, 1070 Brussels, Belgium.
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