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Special features of neurogenic control of the heart in patients with severe heart failure: interrelation of efferent reactivity potential and baroreflex regulation of a heart rhythm

Mamontov O. V., Kozlenok A. V., Kozlova S. N., Shlyakhto E. V.
Federal State Budgetary Institution, “North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: baroreflex dysfunction, diagnostics, neurogenic heart control, CHF

DOI: 10.18087 / rhfj.2012.4.1705

Relevance. Neurogenic heart regulation disorder can be connected both with baroreflex dysfunction and with decreased neurogenic reactivity, and the intensity remains more often unclear. Objective. Define character and intensity of the heart rhythm neurogenic control disorder and estimate clinical pathogenetic value of various factors of chronotropic dysfunctions in patients with severe CHF. Materials and methods. 40 patients with CHF II–IV FC, EF 35.4±14.8 %, average age 56.4±8.1, were studied. 55 % patients had coronary, 33 % – noncoronary, and 12 % combined myocardial pathology. All patients underwent examination of the heart autoregulation: tilt-test, estimation arterial baroreflex (ABR), Valsalva’s index (VI). Parameters were registered by BP monitor Finometer (FMS) with parallel recording of electrocardiogram and subsequent spectral analysis of cardiac rhythm (HRV). Results. It has been revealed that patients in comparison with a group of volunteers comparable by age had reduced ABR (6.1±2.8 and 10.1±5.4 ms / mm Hg, р<0.001) and VI (1.41±0.26 and 1.84±0.37, р<0.001), as well as HRV in all frequency ranges. In the control group, correlation between general HRV and VI (r=0.43; p<0.005) was established, but stronger connection with ABR level (r=0.58; p<0.001). In CHF patients, strong correlation of general HRV with VI was also revealed: r=0.59; p<0.001, still HRV was not connected with ABR level in any range. Strong connection of VI with FC was established in patients (F=3.4; p<0.05) and CHF stage (F=13.5; p<0.001), EF (r=0.47, p<0.005), LV systolic and diastolic volume (r = –0.48; p<0.005 and –r = –0.46; p<0.005 respectively), and also BNP level (–r = –0.49 p=0.001). On the other hand, VI had inverse relationship with the intencity of ventricular arrhythmia according to М. Ryan classification (F=2.6, p<0.05) whereas ABR was connected with angina FC (F=4.2, p<0.05). Conclusion. At severe CHF, regulation of cardiac rhythm is limited by the efferent chronotropic potential which reduction is caused by contractility disorder and is associated with factors of a bad forecast while arterial baroreflex dysfunction is connected with intensity anginous syndrome. Valsalva’s index can be used for screening estimation of myocardial lesion severity in CHF patients.
  1. La Rovere M, Bigger J, Marcus F et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998;351 (9101):478–484.
  2. Lanza G, Guido V, Galeazzi M et al. Prognostic role of heart rate variability in patients with recent acute myocardial infarction. Am J Cardiol. 1998;82 (11):1323–1328.
  3. Cygankiewicz I, Zareba W, Vazquez R et al. Risk stratification of mortality in patients with heart failure and left ventricular ejection fraction >35 %. Am J Cardiol. 2009;103 (7):1003–1010.
  4. Gerritsen J, Dekker JM, TenVoorde BJ et all. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care. 2001;24 (10):1793–1798.
  5. Pop-Busui R. Cardiac Autonomic Neuropathy in Diabetes. A clinical perspective. Diabetes Care. 2010; 33 (2): 434–441.
  6. Vinik AI, Maser RE, Mitchell BD et al. Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26 (5):1553–1579.
  7. Negrao CE, Middlekauff HR. Adaptations in autonomic function during exercise training in heart failure. Heart Fail Rev. 2008;13 (1):51–60.
  8. Munhoz RT, Negrao CE, Barretto AC et al. Microneurography and venous occlusion plethysmography in heart failure: correlation with prognosis. Arq Bras Cardiol. 2009;92 (1):46–53.
  9. Remme WJ. Pathophysiology and therapy of heart failure, new insights and developments. Part II. Cardiac and peripheral alterations during progressive heart failure. Neth J Med. 1993;43 (3-4):125–146.
  10. Francis GS. Neuroendocrine manifestations of congestive heart failure. Am J Cardiol. 1988;62 (2):9A-13A.
  11. La Rovere MT, Maestri R, Robbi E et al. Comparison of the prognostic values of invasive and noninvasive assessments of baroreflex sensitivity in heart failure. J Hypertens. 2011;29 (8):1546–1552.
  12. Fahim M, Gao L, Mousa TM et al. Abnormal baroreflex function is dissociated from central angiotensin II receptor expression in chronic heart failure. Shock. 2012;37 (3):319–324.
  13. Bravi A, Longtin A, Seely AJ. Review and classification of variability analysis techniques with clinical applications. Biomed Eng Online. 2011;10:90.
  14. Wakabayashi T, Nakata T, Hashimoto A et al. Assessment of underlying etiology and cardiac sympathetic innervation to identify patients at high risk of cardiac death. J Nucl Med. 2001;42 (12):1757–1767.
  15. Azevedo ER, Parker JD. Parasympathetic control of cardiac sympathetic activity: normal ventricular function versus congestive heart failure. Circulation. 1999;100 (3):274–279.
  16. Junqueira LF Jr. Teaching cardiac autonomic function dynamics employing the Valsalva (Valsalva-Weber) maneuver. Adv Physiol Educ. 2008;32 (1):100–106.
  17. Zema MJ, Caccavano M, Kligfield P. Detection of left ventricular dysfunction in ambulatory subjects with the bedside Valsalva maneuver. Am J Med. 1983;75 (2):241–248.
  18. Felker GM, Cuculich PS, Gheorghiade M. The Valsalva maneuver: a bedside «biomarker» for heart failure. Am J Med. 2006;119 (2):117–122.
  19. Raj SR, Robertson D, Biaggioni I, Diedrich A. Abnormal valsalva maneuver is not always a sign of congestive heart failure. Am J Med. 2007;120 (6):e15–6.
  20. Nolan J, Batin P, Andrews R et al. Prospective study of heart rate variability and mortality in chronic heart failure; results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART). Circulation. 1998;98 (15):1510–1516.
  21. Yi G, Goldman JH, Keeling PJ et al. Heart rate variability in idiopathic dilated cardiomyopathy: relation to disease severity and prognosis. Heart. 1997;77 (2):108–114.
  22. Link JM, Caldwell JH. Diagnostic and prognostic imaging of the cardiac sympathetic nervous system. Nat Clin Pract Cardiovasc Med. 2008;5 (Suppl 2):S79–86.
  23. Bibevski S, Dunlap ME. Evidence for impaired vagus nerve activity in heart failure. Heart Fail Rev. 2011;16 (2):129–135.
  24. Mostarda C, Moraes-Silva IC, Moreira ED et al. Baroreflex sensitivity impairment is associated with cardiac diastolic dysfunction in rats. J Card Fail. 2011;17 (6):519–525.
  25. Milan A, Caserta MA, Del Colle S et al. Baroreflex sensitivity correlates with left ventricular morphology and diastolic function in essential hypertension. J Hypertens. 2007;25 (8):1655–1664.
  26. Daneshvar D, Wei J, Tolstrup K et al. Diastolic dysfunction: improved understanding using emerging imaging techniques. Am Heart J. 2010;160 (3):394–404.
Mamontov O. V., Kozlenok A. V., Kozlova S. N. et al. Special features of neurogenic control of the heart in patients with severe heart failure: interrelation of efferent reactivity potential and baroreflex regulation of a heart rhythm. Russian Heart Failure Journal. 2012;13(4):213-221

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