Reduction in lymphocyte beta-adrenergic receptor density in infants and children with heart failure secondary to congenital heart disease.
To identify changes in catecholamine levels and beta-adrenergic receptor density in children with varying degrees of congestive heart failure, we measured plasma norepinephrine (NE), epinephrine, and beta-adrenergic receptor levels in 91 noncyanotic patients using high-performance liquid chromatography and a radioligand binding assay. Plasma NE levels in 41 patients with heart failure (694 +/- 236 pg/ml) were significantly higher than those in 50 patients without it (274 +/- 68 pg/ml, p < 0.001). In addition, beta-adrenergic receptor density was significantly lower in patients with heart failure (0.81 +/- 0.48 fmol/10(6) cells) than in those without it (2.43 +/- 1.09 fmol/10(6) cells, p < 0.001), but epinephrine levels were not significantly different between the 2 groups. The receptor reduction in heart failure correlated well with elevated plasma NE levels (r = -0.60, p < 0.001). The degree of left to right shunt flow and pulmonary systolic pressure correlated directly with plasma NE levels and inversely with beta-adrenergic receptor density. From the best compromise between sensitivity and specificity, the optimal cutoff point for heart failure was > 390 ng/ml for NE and < 1.30 fmol/10(6) cells for beta-adrenergic receptor density, respectively. A follow-up study in 15 of 30 patients with heart failure after surgery showed a significant decrease in plasma NE and an increase in beta-adrenergic receptor density. Changes in plasma NE levels and beta-adrenergic receptor density occur concurrently with clinical symptoms of heart failure and may be used as indexes for assessing the presence and severity of heart failure in infants and children.
Department of Pediatrics, School of Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
J R
JR
Wu
H R
HR
Chang
T Y
TY
Huang
C H
CH
Chiang
S S
SS
Chen
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D004837:Epinephrine / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications*; D006333:Heart Failure / Q000097:blood* / Q000209:etiology; D006801:Humans; D007223:Infant; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D009638:Norepinephrine / Q000097:blood; D011943:Receptors, Adrenergic, beta / Q000378:metabolism*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D011943:Receptors, Adrenergic, beta; D009638:Norepinephrine; D004837:Epinephrine