Abstract:
OBJECTIVES:In view of previous experimental evidence relating sympathetic nervous overactivity in the heart to myocardial necrosis and ventricular arrhythmias, we prospectively examined the hypothesis that heightened cardiac sympathetic nervous activity is associated with an adverse outcome in patients with moderate to severe heart failure. BACKGROUND:Despite recent therapeutic advances, patients with heart failure continue to have high mortality from progressive hemodynamic decompensation and lethal ventricular arrhythmias. It is believed that initially compensatory increases in sympathetic nervous system activity may ultimately be maladaptive, potentially contributing to subsequent adverse events. METHODS:Sixty patients with moderate to severe heart failure (left ventricular ejection fraction 18.9 +/- 0.9% [mean +/- SE]) were studied prospectively. In addition to the compilation of a hemodynamic, biochemical and electrocardiographic profile for each patient, whole-body and cardiac sympathetic activity were determined by isotope dilution. The relation of these variables to outcome was determined by Cox proportional hazards analysis. RESULTS:The mean follow-up period of the study group was 7 +/- 1 months (range 1 to 24) with a 12-month actuarial survival of 75%. Deaths (14 in all) were accounted for either by sudden death or progressive heart failure in equal numbers. The rate of release of norepinephrine from the heart was significantly higher in patients with heart failure than in healthy subjects (402 +/- 37 vs. 105 +/- 19 pmol/min, p < 0.01), although the values for heart failure ranged widely from normal to 10 times normal. By univariate Cox proportional hazards analysis, pulmonary capillary wedge pressure (p < 0.01), mean pulmonary artery pressure (p < 0.001), serum sodium levels (p < 0.01) and cardiac norepinephrine spill-over rate (p < 0.001) were identified as significant prognostic markers. In a multivariate analysis, cardiac norepinephrine spillover rate was identified as the most powerful prognostic marker (p = 0.0006) of those evaluated in this study. CONCLUSIONS:These results suggest that activation of the sympathetic nervous system in patients with heart failure, specifically the cardiac sympathetic nerves, may contribute to the poor prognosis associated with severe heart failure. The data therefore provide a rationale for the use of drugs such as beta-adrenergic blocking agents in the management of patients with heart failure.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Kaye DM,Lefkovits J,Jennings GL,Bergin P,Broughton A,Esler MDdoi
10.1016/0735-1097(95)00332-0subject
Has Abstractpub_date
1995-11-01 00:00:00pages
1257-63issue
5eissn
0735-1097issn
1558-3597pii
0735-1097(95)00332-0journal_volume
26pub_type
杂志文章abstract::Forty-two defibrillating lead systems for the automatic implantable defibrillator were implanted and tested in 41 patients. Two basic lead configurations were used: 1) spring-patch, consisting of a transvenous superior vena cava spring electrode as the anode and an apical or left lateral ventricular patch electrode (e...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80219-9
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVES:The present study examined whether sudden death in patients with hypertrophic cardiomyopathy occurred with a particular pattern of frequency throughout the day. BACKGROUND:Previous investigators have shown a circadian distribution in the occurrence of sudden death and other cardiovascular events in patients...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(94)90384-0
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更新日期:2006-04-18 00:00:00
abstract:OBJECTIVES:We present a new method in which a priori knowledge of the blood velocity fields within the boundary layer at the vessel wall, combined with acquisition of high resolution magnetic resonance imaging (MRI) blood velocity data, allow exact modeling at the subpixel level. BACKGROUND:Methods are lacking for acc...
journal_title:Journal of the American College of Cardiology
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更新日期:1998-07-01 00:00:00
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doi:10.1016/j.jacc.2012.03.071
更新日期:2012-08-28 00:00:00
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(98)00478-1
更新日期:1998-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2000-04-01 00:00:00
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更新日期:2009-04-28 00:00:00
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更新日期:2011-02-08 00:00:00
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更新日期:2004-08-18 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2015-05-19 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2001-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00196-x
更新日期:1998-07-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(86)80194-2
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更新日期:2012-04-03 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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更新日期:1998-06-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1992-06-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
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更新日期:2005-02-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1995-10-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(90)90621-u
更新日期:1990-03-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90533-s
更新日期:1992-03-15 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.10.084
更新日期:2014-03-25 00:00:00
abstract:OBJECTIVES:This study investigated the extent of fractionation of paced right atrial electrograms in patients with and without paroxysmal atrial flutter (AFL) or atrial fibrillation (AF). BACKGROUND:Slow conduction through nonuniform anisotropic atrial muscles, represented by fractionated electrograms, may favor the g...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:2001-05-01 00:00:00