title: Relation of impaired interorgan communication and parasympathetic activity in chronic heart failure and multiple-organ dysfunction syndrome.
abstract: BACKGROUND
  We investigated the relationship of impaired autonomic function and severity of illness in chronic heart failure (CHF) and multiple-organ dysfunction syndrome (MODS) as an end stage of CHF. Furthermore, we assessed the link of parasympathetic modulation of the heart rate and inflammatory activation in CHF and MODS.
  
  
  METHODS
  Sixty-five patients admitted for worsening of CHF were retrospectively enrolled in this study. In addition, 65 age- and sex-matched patients with pronounced MODS were assigned for comparison of autonomic function and C-reactive protein in patients with CHF or MODS, respectively. Heart rate variability (HRV) parameters of the time and frequency domain as markers of autonomic function were analyzed from 24-hour Holter electrocardiograms.
  
  
  RESULTS
  The more pronounced the severity of illness as expressed by the Acute Physiology and Chronic Health Evaluation score, the more the HRV was impaired. This effect was particularly seen for overall variability (SD of RR intervals) and HRV parameters characterizing the parasympathetic modulations of the heart rate (high, very low frequency power). C-reactive protein levels as markers of inflammation were inversely related to high and very low frequencies.
  
  
  CONCLUSIONS
  Our results allow for speculation that autonomic dysfunction in CHF indicates a beginning of uncoupled interorgan communication potentially leading to MODS as characterized by disruption of communication between the organs.
authors: Department of Cardiology and Diabetology, Klinikum Magdeburg, Magdeburg, Germany; Department of Cardiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany. Electronic address: hendrik.schmidt@klinikum-magdeburg.de.
authors: H
authors: H
authors: Schmidt
authors: Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Bad Frankenhausen, Germany.
authors: U
authors: U
authors: Lotze
authors: Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Bad Frankenhausen, Germany.
authors: A
authors: A
authors: Ghanem
authors: University Medicine, Charite, Campus Virchow, Berlin, Germany.
authors: S D
authors: SD
authors: Anker
authors: Department of Cardiology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
authors: S M
authors: SM
authors: Said
authors: Department of Cardiology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
authors: R
authors: R
authors: Braun-Dullaeus
authors: Department of Internal Medicine, DRK-Krankenhaus Sömmerda, Sömmerda, Germany.
authors: G
authors: G
authors: Oltmanns
authors: Department of Cardiology and Diabetology, Klinikum Magdeburg, Magdeburg, Germany.
authors: S
authors: S
authors: Rose
authors: Department of Cardiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, St. Marienkrankenhaus Siegen, Siegen, Germany.
authors: M
authors: M
authors: Buerke
authors: Department of Cardiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
authors: U
authors: U
authors: Müller-Werdan
authors: Department of Cardiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
authors: K
authors: K
authors: Werdan
authors: University Medicine, Charite, Campus Virchow, Berlin, Germany.
authors: M
authors: M
authors: Rauchhaus
mesh_terms: D018806:APACHE; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D002908:Chronic Disease; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000276:immunology / Q000503:physiopathology*; D010275:Parasympathetic Nervous System / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein
keywords: Chronic heart failure; Heart rate variability; Inflammatory activity; Multiple-organ dysfunction syndrome; Parasympathetic activity