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[Influence of the neurohumoral system on left ventricular performance in chronic congestive heart failure]
A V Mattioli1, M G Modena, L Masciocco
1Cattedra di Malattie Cardiovascolari, Università degli Studi, Modena.
Insights
High norepinephrine levels in chronic heart failure patients correlate with reduced ejection fraction (EF). The adrenergic system appears more influential on cardiac performance than the renin-angiotensin system.
Area of Science:
- Cardiology
- Neuroendocrinology
- Internal Medicine
Background:
- Neurohumoral system activation, including adrenergic and renin-angiotensin systems, plays a role in heart failure pathophysiology.
- The specific impact of these systems on cardiac performance in chronic heart failure remains incompletely understood.
Purpose of the Study:
- To investigate the influence of neurohumoral activation, specifically the adrenergic and renin-angiotensin systems, on cardiac performance in patients with chronic heart failure.
- To determine the relative importance of the adrenergic system versus the renin-angiotensin system in modulating ejection fraction (EF) in this patient population.
Main Methods:
- A cohort of 51 patients with chronic heart failure (NYHA class II-III) was studied.
- Ejection fraction (EF) was assessed at baseline and 8 months using radionuclide ventriculography (RVG).
- Plasmatic norepinephrine levels and renin activity were measured to evaluate adrenergic and renin-angiotensin system activation, respectively.
Main Results:
- Patients with high plasmatic norepinephrine levels exhibited a significant reduction in EF (-3.73 +/- 1.27%).
- Conversely, patients with normal norepinephrine levels showed a slight increase in EF (+2.57 +/- 4.32%).
- No significant difference in EF changes was observed between patients with normal or high plasmatic renin activity.
Conclusions:
- Elevated adrenergic system activity, indicated by high plasmatic norepinephrine, is associated with impaired cardiac performance (reduced EF) in chronic heart failure.
- The adrenergic system appears to exert a more significant influence on cardiac performance in chronic heart failure compared to the renin-angiotensin system.
- These findings highlight the critical role of adrenergic modulation in managing heart failure.
Abstract:
he influence of the neurohumoral system, as adrenergic system or renin-angiotensin system, on cardiac performance in heart failure is not yet know. In order to evaluate the influence of neurohumoral activation in chronic heart failure we followed 51 patients, 47 males and 4 females of mean age 58 +/- 10 years. They suffered from chronic heart failure of different origin and were classified according to NYHA classification: 42 patients were in class III and 9 were in class II. They were treated with digoxin and diuretics since long time. Ejection fraction (EF) was obtained by RVG at baseline and 8 months later. In order to test the influence of adrenergic system on EF we checked plasmatic norepinephrine levels and we divided the patients in two groups: Group A with high levels of plasmatic norepinephrine (1114 +/- 594 pg/ml) and Group B with normal level (426 +/- 139 pg/ml). Group A showed a reduction of EF (-3.73 +/- 1.27%) while, Group B showed a small increase of EF (+ 2.57 +/- 4.32%). To test the influence of renin-angiotensin system we also evaluated the patients according to the value of plasmatic renin activity: normal or high level. We did not observe a significant difference between the 2 groups. Patients with high plasmatic norepinephrine value presented a significant reduction of EF compared to those with low plasmatic norepinephrine. The adrenergic system seems to be more important than renin-angiotensin system or cardiac performance.