title: Aberrant central nervous system responses to the Valsalva maneuver in heart failure.
abstract: Heart failure (HF) is associated with aberrant autonomic nervous system (ANS) activity, with altered responses to blood pressure and breathing challenges that appear to reflect abnormal central nervous system function. The authors used functional magnetic resonance imaging (fMRI) to determine whether the Valsalva maneuver, an ANS challenge, would show abnormal responses in ANS regulatory areas of the brain in HF. Brain fMRI signal changes in 5 HF patients (left ventricular ejection fraction, 0.15+/-0.08; age, 50+/-10 years) and 14 controls (age, 47+/-11 years) were assessed during 3 successive Valsalva maneuvers. The hypothalamus, hippocampus, putamen, amygdala, mid-cingulate, right insula, and cerebellar cortex showed exaggerated and phase-shifted fMRI responses in HF; other areas showed inverted signals from those found in controls. Central ANS control areas have altered phase, extent, and direction of responses to Valsalva maneuvers in a small sample of HF patients. These findings suggest that therapeutics that address neuroprotective aspects may be useful interventions for the condition.
authors.affiliation: School of Nursing, David Geffen School of Medicine at UCLA, CA 90095-1702, USA. mwoo@sonnet.ucla.edu
authors.forename: Mary A
authors.initials: MA
authors.lastname: Woo
authors.forename: Paul M
authors.initials: PM
authors.lastname: Macey
authors.forename: Peter T
authors.initials: PT
authors.lastname: Keens
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Michele A
authors.initials: MA
authors.lastname: Hamilton
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Harper
mesh_terms: D002490:Central Nervous System / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014636:Valsalva Maneuver / Q000502:physiology*