Autonomic nervous system dysfunction in advanced systolic heart failure.
BACKGROUND
An alteration of the autonomic nervous system has been described in heart failure (HF). The aim of this study was to assess, compare and relate the impairment of both arms of the autonomic nervous systems, the sympathetic and parasympathetic (SNS and PNS) in a same group of patients.


METHODS
We analyzed 23 patients with advanced HF (NYHA III-IV/IV and IV/IV) and EF<35% who were on the waiting list for heart transplantation. We assessed the SNS by determining cardiac uptake of (123)I metaiodobenzylguanidine, and analyzed the heart mediastinum rate (HMR) and the myocardial washout rate (WR). The PNS was assessed by 24-hour Holter ECG recording and subsequent analyses of heart rate turbulence (HRT) in which turbulence onset (TO) and turbulence slope (TS) were determined.


RESULTS
In the study of the SNS, HMR values were 1.32 ± 0.12, and WR 0.36 ± 0.1. Higher creatinine levels were associated with a lower WR (r=-0.604; p=0.02). In the study of the SNP, TO was higher the lower the LVEF (r=-0.410; p=0.052), and age was associated with a lower TS (r=-0.4; p=0.059). In the study of the relationships between the SNS and PNS, HMR was correlated in a nearly significant manner with TO (r=-0.399; p=0.059) and WR with TS (r=-0.447; p=0.033).


CONCLUSIONS
In stable patients with advanced HF (NYHA III-IV and IV/IV), a significant and parallel impairment occurs in both arms of the autonomic nervous system. This could have prognostic implications and would help to prioritize patients on the waiting list for heart transplantation.
Sánchez-Lázaro
Ignacio J
IJ
Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitario La Fe, Valencia, Spain. ignaciosanchezlazaro@gmail.com
Cano-Pérez
Oscar
O
Ruiz-Llorca
Cristina
C
Almenar-Bonet
Luis
L
Sancho-Tello
María José
MJ
Martínez-Dolz
Luis
L
Navarro-Mateo
Antonio
A
Sanz
Antonio Salvador
AS
D019797:3-Iodobenzylguanidine; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D015716:Electrocardiography, Ambulatory; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine