title: Autonomic nervous system dysfunction in advanced systolic heart failure.
abstract: 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.
authors.affiliation: Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitario La Fe, Valencia, Spain. ignaciosanchezlazaro@gmail.com
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Sánchez-Lázaro
authors.forename: Oscar
authors.initials: O
authors.lastname: Cano-Pérez
authors.forename: Cristina
authors.initials: C
authors.lastname: Ruiz-Llorca
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar-Bonet
authors.forename: María José
authors.initials: MJ
authors.lastname: Sancho-Tello
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Dolz
authors.forename: Antonio
authors.initials: A
authors.lastname: Navarro-Mateo
authors.forename: Antonio Salvador
authors.initials: AS
authors.lastname: Sanz
mesh_terms: 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
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine