- Email: [email protected]
Respiratory suppression of sympathetic nerve activity in patients with chronic heart failure
84
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 2 1998
077
078
RESPIRATORY SUPPRESSION OF SYMPATHETIC NERVE ACTIVITY IN PATIENTS WITH CHRONIC HEART FAILURE Yukiko Gosou, Hidetsugu Asanoi, Junya Takagawa, Hisaneri Ishise, Tomoki Kameyama, Tadakazu Hirai, Takashi Nozawa, Shutaro Takashima, Hiroshi Inoue
PLASMA BRAIN NATRIURETIC PEPTIDE AND REGULATION OF AUTONOMIC ACTIVITY IN C H R O N I C H E A R T FAILURE DURING P O S T U R A L TILT Ichiro K o u h a r a , Y u t a k a Kimura, Hui He, Toshiji I w a s a k a C a r d i o v a s c u l a r Center, Kansai M e d i c a l University Moriguchi 570-8570, J a p a n
The Second Depadment of Internal Medicine, Toyama Medical & PharmaceuticalUniversity, Toyama 930-0194,Japan To elucidatethe respiratorymodulationof sympatheticnerve activity in patients with chronic heartfailure, we examinedwithin-breathvariationin skeletal muscle sympathetic nerve activity ( MSNA ). Sixteen patients ( EF < 46 % ) with heart failure were divided into two groups accordingto the presenceof sympathetic neural silence ( SNS + :10 cases, SNS -: 6 cases ) synchronized with late inspiration. Patientswithout SNS showed a lower specific activity scale ( 5.5 vs. 7.5 mets, p< 0.01 ) and a higher plasmanorepinephrinelevel ( 327 vs. 164 pg/ml, p<0.01 ) as compared to patients with SNS, indicating that patients without SNS were under more compromisedconditions. Although the burst incidenceof MSNAduring control breathingwas lower ( 62 vs. 96/100beats, p< 0.01 ) in patientswith SN$ than in those without SNS, there was no significant difference in the burst augmentation( 8 vs. 9/10beats ) during long expiratory phase ( >10 sec ) between two groups. These findings suggest that the efficiency of inspiratory inhibition of tonic sympathetic outflow could play an important role in the baselinesympathoexcitationseen in patients with chronic
To evaluate the relationship between autonomic activity and neurohumoral regulation in chronic heart failure (CHF), RR interval (RR), systolic blood pressure (P) variability during tilt test and plasma Brain Natriuretic Peptide (BNP) was assessed in 7 patients with CHF. Left ventricular ejection fraction was 44.8+9.9 % and mean age was 65+_11 yrs (male 4, female 3). Blood pressure was monitored by radial arterial tonometry before and during 70 degree head up tilt test. Power spectral analysis of RR and systolic blood pressure was performed at rest and during head up tilt. Low frequency (LF:0.04~0.15 Hz), high frequency (HF:0.15-0.40) of RR and the ratio of LF and HF ( LF / HF ) were estimated. RR interval did not changed significantly during tilt. RR-LF/HF decreased from 2.09_+1,30 to 1.28_+0.37 and P-LF/HF increased from 0.41 ±0.14 to 0.57+_0.23 during tilt ( p < 0.1, p < 0.05, respectively ). BNP ranged from 6 to 600 pg / ml and good correlation with the number of NYHA ( r=0.79, p < 0.05 ). There was poor relation between RRLF/HF, P-LF/HF and BNP at rest. However, BNP correlated negatively with RR-LF/HF during tilt ( r=-0.75, p<0.1) and correlated positively with P-LF/HF during tilt (r=0.78, p <0.05). These finding suggest that autonomic activity may in part play an important role in the regulation of BNP in chronic heart failure.
heart failure.
080
079 THE ACUTE EFFECTS ON THE AUTONOMIC NERVOUS SYSTEM BY NIFEDIPINE ADMINISTRATION Masatsugu Uchida, Seiji Kushi, Takashi Serizawa, Hiroshi Matsuo, Sato Hiroshi* Saitama Medical School, 2nd Dpt. of Internal Medicine, Saitama 350-0451, Japan Institute of Cardiovascular Disease*, Tokyo 03-3408, Japan Using each methods of Heart Rate Variability (HRV) and Baroreflex Sensitivity (BRS), we observed the acute effects on the autonomic nervous system of patients with coronary artery disease (CAD) under nifedipine (nif.) administration. [Method] Eight men (average age, 52 yrs) were included in this study. Systolic blood pressure (SBP)and R-R interval (RRI) were recorded during 60 min and nifedipine (10mg) P.O. at 15 min. after starting record. Three power spectrums, ie. LF(0.04 -0.15 Hz), HF(0.15 - 0.5Hz) and TP(total power) of RRI for every 5min. were obtained by FFT. We designed sympathetic activity as Iog(LF/HF), parasympathetic one as Iog(HFITP) and HRV as Iog(TP). BRS is the average slope of the linear regression lines of RRI over SBP for every 5 min.. [Results] The results are shown in the table below. {control 10 min. (cont.10) vs.15 min. after nif. P.O.(nif.15), P<0.05} cont. 10
nil. 1S
HR 58_+10.3 70_+8.76 SBP(mmHg) 123_+23.1 103_+9.27 Iog(LF/HF) 0.12+0.41 0.31_+0.12 Iog(HF) 1.95 _+0.44 0.43 -+0.43 BRS(ms/mmHg) 10.4_+5.75 7.37_+3.50 [Conclusion] When SBP decreased suddenly after nif. administration, the sympathetic activity increased, the parasympathetic activity, HRV and BRS decreased.. These )henomena may influence the CAD prognosis to the worse.
BENEFICIAL EFFECTS OF CAPTOPRIL AND METOPROLOL ON VENTRICULAR ARRHYTHMIAS AND AUTONOMIC NERVOUS ACTIVITY IN PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY Fumishi Tomita, Tetsuro Kohya, Tohru Kaji, Hisashi Yokoshiki, Yoshinori Itoh, Masanori Konno, Motoi Sasaki, Masayuki Sakurai, Akira Kitabatake Department of Cardiovascular Medicine, Hokkaido University, Sapporo 060-8638, Japan We assessed the effects of captopril and metoprolol on ventricular arrhythmias (VA) and autonomic nervous activity (ANA) in patients with idiopathic dilated cadiomyopathy (DCM), using 24-hour ambulatory electrocardiographic monitoring (AEM) and power spectral analysis of heart rate variability. Thirty-nine patients with DCM (55-+ 11 years) allocated to a captopril (Gr-A) and a metoprolol (Gr-B) treatment groups, and AEM was performed before and after 12-week treatment period. In case of sinus rhythm, power spectra were quantified in high- (HF) and low- (LF) frequency power, and natural logarithmic values of HF (In(HF)) and LF/HF (In(LF/HF)) were used as indexes of parasympathetic and sympathetic nervous activities, respectively. The results were as follows. PVC(/day) VT(/day) In(HF) In(LF/HF) Gr-A 1721-+640 2.6±0.9 3.7÷0.8 1.5_+1.1 1164_+613 0.7_+0.2 * 4.2+_0.8 * 1.1_+1.0 Gr-B 1757_+559 3.1 _+1.1 4.0_+ 1.0 1.6--+0.8 1090~-411 * 1.5_+0.7 4.6_+1.2 * 1.2-+1.0 • : p<0.05 In addition, there was a significant relationship between the suppression of VT and the decrease in In(LF/HF) (p<0.05). We conclude that both captopril and metoprolol have beneficial effects on VA and ANA in DCM, and the improvement of VA and the restoration of autonomic imbalance correlate to each other.
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 2 1998
077
078
RESPIRATORY SUPPRESSION OF SYMPATHETIC NERVE ACTIVITY IN PATIENTS WITH CHRONIC HEART FAILURE Yukiko Gosou, Hidetsugu Asanoi, Junya Takagawa, Hisaneri Ishise, Tomoki Kameyama, Tadakazu Hirai, Takashi Nozawa, Shutaro Takashima, Hiroshi Inoue
PLASMA BRAIN NATRIURETIC PEPTIDE AND REGULATION OF AUTONOMIC ACTIVITY IN C H R O N I C H E A R T FAILURE DURING P O S T U R A L TILT Ichiro K o u h a r a , Y u t a k a Kimura, Hui He, Toshiji I w a s a k a C a r d i o v a s c u l a r Center, Kansai M e d i c a l University Moriguchi 570-8570, J a p a n
The Second Depadment of Internal Medicine, Toyama Medical & PharmaceuticalUniversity, Toyama 930-0194,Japan To elucidatethe respiratorymodulationof sympatheticnerve activity in patients with chronic heartfailure, we examinedwithin-breathvariationin skeletal muscle sympathetic nerve activity ( MSNA ). Sixteen patients ( EF < 46 % ) with heart failure were divided into two groups accordingto the presenceof sympathetic neural silence ( SNS + :10 cases, SNS -: 6 cases ) synchronized with late inspiration. Patientswithout SNS showed a lower specific activity scale ( 5.5 vs. 7.5 mets, p< 0.01 ) and a higher plasmanorepinephrinelevel ( 327 vs. 164 pg/ml, p<0.01 ) as compared to patients with SNS, indicating that patients without SNS were under more compromisedconditions. Although the burst incidenceof MSNAduring control breathingwas lower ( 62 vs. 96/100beats, p< 0.01 ) in patientswith SN$ than in those without SNS, there was no significant difference in the burst augmentation( 8 vs. 9/10beats ) during long expiratory phase ( >10 sec ) between two groups. These findings suggest that the efficiency of inspiratory inhibition of tonic sympathetic outflow could play an important role in the baselinesympathoexcitationseen in patients with chronic
To evaluate the relationship between autonomic activity and neurohumoral regulation in chronic heart failure (CHF), RR interval (RR), systolic blood pressure (P) variability during tilt test and plasma Brain Natriuretic Peptide (BNP) was assessed in 7 patients with CHF. Left ventricular ejection fraction was 44.8+9.9 % and mean age was 65+_11 yrs (male 4, female 3). Blood pressure was monitored by radial arterial tonometry before and during 70 degree head up tilt test. Power spectral analysis of RR and systolic blood pressure was performed at rest and during head up tilt. Low frequency (LF:0.04~0.15 Hz), high frequency (HF:0.15-0.40) of RR and the ratio of LF and HF ( LF / HF ) were estimated. RR interval did not changed significantly during tilt. RR-LF/HF decreased from 2.09_+1,30 to 1.28_+0.37 and P-LF/HF increased from 0.41 ±0.14 to 0.57+_0.23 during tilt ( p < 0.1, p < 0.05, respectively ). BNP ranged from 6 to 600 pg / ml and good correlation with the number of NYHA ( r=0.79, p < 0.05 ). There was poor relation between RRLF/HF, P-LF/HF and BNP at rest. However, BNP correlated negatively with RR-LF/HF during tilt ( r=-0.75, p<0.1) and correlated positively with P-LF/HF during tilt (r=0.78, p <0.05). These finding suggest that autonomic activity may in part play an important role in the regulation of BNP in chronic heart failure.
heart failure.
080
079 THE ACUTE EFFECTS ON THE AUTONOMIC NERVOUS SYSTEM BY NIFEDIPINE ADMINISTRATION Masatsugu Uchida, Seiji Kushi, Takashi Serizawa, Hiroshi Matsuo, Sato Hiroshi* Saitama Medical School, 2nd Dpt. of Internal Medicine, Saitama 350-0451, Japan Institute of Cardiovascular Disease*, Tokyo 03-3408, Japan Using each methods of Heart Rate Variability (HRV) and Baroreflex Sensitivity (BRS), we observed the acute effects on the autonomic nervous system of patients with coronary artery disease (CAD) under nifedipine (nif.) administration. [Method] Eight men (average age, 52 yrs) were included in this study. Systolic blood pressure (SBP)and R-R interval (RRI) were recorded during 60 min and nifedipine (10mg) P.O. at 15 min. after starting record. Three power spectrums, ie. LF(0.04 -0.15 Hz), HF(0.15 - 0.5Hz) and TP(total power) of RRI for every 5min. were obtained by FFT. We designed sympathetic activity as Iog(LF/HF), parasympathetic one as Iog(HFITP) and HRV as Iog(TP). BRS is the average slope of the linear regression lines of RRI over SBP for every 5 min.. [Results] The results are shown in the table below. {control 10 min. (cont.10) vs.15 min. after nif. P.O.(nif.15), P<0.05} cont. 10
nil. 1S
HR 58_+10.3 70_+8.76 SBP(mmHg) 123_+23.1 103_+9.27 Iog(LF/HF) 0.12+0.41 0.31_+0.12 Iog(HF) 1.95 _+0.44 0.43 -+0.43 BRS(ms/mmHg) 10.4_+5.75 7.37_+3.50 [Conclusion] When SBP decreased suddenly after nif. administration, the sympathetic activity increased, the parasympathetic activity, HRV and BRS decreased.. These )henomena may influence the CAD prognosis to the worse.
BENEFICIAL EFFECTS OF CAPTOPRIL AND METOPROLOL ON VENTRICULAR ARRHYTHMIAS AND AUTONOMIC NERVOUS ACTIVITY IN PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY Fumishi Tomita, Tetsuro Kohya, Tohru Kaji, Hisashi Yokoshiki, Yoshinori Itoh, Masanori Konno, Motoi Sasaki, Masayuki Sakurai, Akira Kitabatake Department of Cardiovascular Medicine, Hokkaido University, Sapporo 060-8638, Japan We assessed the effects of captopril and metoprolol on ventricular arrhythmias (VA) and autonomic nervous activity (ANA) in patients with idiopathic dilated cadiomyopathy (DCM), using 24-hour ambulatory electrocardiographic monitoring (AEM) and power spectral analysis of heart rate variability. Thirty-nine patients with DCM (55-+ 11 years) allocated to a captopril (Gr-A) and a metoprolol (Gr-B) treatment groups, and AEM was performed before and after 12-week treatment period. In case of sinus rhythm, power spectra were quantified in high- (HF) and low- (LF) frequency power, and natural logarithmic values of HF (In(HF)) and LF/HF (In(LF/HF)) were used as indexes of parasympathetic and sympathetic nervous activities, respectively. The results were as follows. PVC(/day) VT(/day) In(HF) In(LF/HF) Gr-A 1721-+640 2.6±0.9 3.7÷0.8 1.5_+1.1 1164_+613 0.7_+0.2 * 4.2+_0.8 * 1.1_+1.0 Gr-B 1757_+559 3.1 _+1.1 4.0_+ 1.0 1.6--+0.8 1090~-411 * 1.5_+0.7 4.6_+1.2 * 1.2-+1.0 • : p<0.05 In addition, there was a significant relationship between the suppression of VT and the decrease in In(LF/HF) (p<0.05). We conclude that both captopril and metoprolol have beneficial effects on VA and ANA in DCM, and the improvement of VA and the restoration of autonomic imbalance correlate to each other.