Copyright © 2001 by the European Society of Cardiology.
Effect of cardiac sympathetic nervous activity on mode of death in congestive heart failure
Alfred and Baker Medical Unit, Baker Medical Research Institute, Alfred Hospital, Melbourne, Australia
revised August 1, 2000; accepted August 2, 2000
Abstract
Aims To investigate whether strong cardiac sympathetic activity contributes primarily to sudden death or to worsening heart failure, and to determine the relationship of the size of cardiac noradrenaline stores to the mode of death.
Methods and Results The study population comprised 116 patients with congestive heart failure (ejection fraction 19±7%) and a mean follow-up of 18±19 months. Cardiac sympathetic nervous function was measured using coronary sinus blood sampling and noradrenaline isotope dilution methodology. Cardiac sympathetic activity was estimated from cardiac noradrenaline spillover, and noradrenaline stores from the overflow of the tritiated noradrenaline metabolite [3H]dihydroxyphenylglycol, which is produced by monoamine oxidase inside nerve endings. Small cardiac noradrenaline stores (below median) predicted death from worsening heart failure (hazard ratio=4·18, P<0·05), particularly if cardiac noradrenaline spillover was elevated (hazard ratio=2·36 per tertile, P<0·01), indicating progression of disease associated with defective sympathetic innervation. In contrast, large stores (hazard ratio=2·81, P<0·05), especially if coupled with increased noradrenaline spillover (hazard ratio=1·64 per tertile, P<0·05), were related to sudden death.
Conclusion High cardiac sympathetic activity is a risk factor for sudden death, particularly in the presence of intact cardiac sympathetic innervation. Conversely, progression of myocardial disease and heart failure is closely associated with depletion of sympathetic nerves in the heart, especially if rates of noradrenaline release paradoxically remain high.
Key Words: Heart failure • noradrenaline • sympathetic nervous system • prognosis • sudden death
f1 Correspondence: Hans Peter Brunner-La Rocca, MD, Division of Cardiology, Department of Internal Medicine, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. Kioka, T. Yamada, T. Mine, T. Morita, Y. Tsukamoto, S. Tamaki, M. Masuda, K. Okuda, M. Hori, and M. Fukunami Prediction of sudden death in patients with mild-to-moderate chronic heart failure by using cardiac iodine-123 metaiodobenzylguanidine imaging Heart, October 1, 2007; 93(10): 1213 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Jaumdally, C. Varma, R. J. Macfadyen, and G. Y.H. Lip Coronary sinus blood sampling: an insight into local cardiac pathophysiology and treatment? Eur. Heart J., April 2, 2007; 28(8): 929 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Christ, T. Klima, W. Grimm, H.-H. Mueller, and B. Maisch Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy Eur. Heart J., March 2, 2006; 27(6): 691 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Kreusser, M. Haass, S. J. Buss, S. E. Hardt, S. H. Gerber, R. Kinscherf, H. A. Katus, and J. Backs Injection of Nerve Growth Factor Into Stellate Ganglia Improves Norepinephrine Reuptake Into Failing Hearts Hypertension, February 1, 2006; 47(2): 209 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Gould, M. Yii, M. D. Esler, J. M. Power, and D. M. Kaye Atrial fibrillation impairs cardiac sympathetic response to baroreceptor unloading in congestive heart failure Eur. Heart J., December 1, 2005; 26(23): 2562 - 2567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Floras Atrial fibrillation and cardiac sympathetic reflexes in heart failure Eur. Heart J., December 1, 2005; 26(23): 2490 - 2492. [Full Text] [PDF]
|
|
|
|
|
|
J. Spaak, Z. J. Egri, T. Kubo, E. Yu, S.-I. Ando, Y. Kaneko, K. Usui, T. D. Bradley, and J. S. Floras Muscle Sympathetic Nerve Activity During Wakefulness in Heart Failure Patients With and Without Sleep Apnea Hypertension, December 1, 2005; 46(6): 1327 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. M. Bengel When the Heart Loses Its Nerves...and How Nuclear Imaging Helps to Understand J. Nucl. Med., August 1, 2005; 46(8): 1252 - 1253. [Full Text] [PDF]
|
|
|
|
|
|
M. Petersson, P. Friberg, G. Eisenhofer, G. Lambert, and B. Rundqvist Long-term outcome in relation to renal sympathetic activity in patients with chronic heart failure Eur. Heart J., May 1, 2005; 26(9): 906 - 913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Chowdhary, A. M. Marsh, J. H. Coote, and J. N. Townend Nitric Oxide and Cardiac Muscarinic Control in Humans Hypertension, May 1, 2004; 43(5): 1023 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Joles and H. A. Koomans Causes and Consequences of Increased Sympathetic Activity in Renal Disease Hypertension, April 1, 2004; 43(4): 699 - 706. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. D. Sin and G. C. W. Man Cheyne-Stokes Respiration: A Consequence of a Broken Heart? Chest, November 1, 2003; 124(5): 1627 - 1628. [Full Text] [PDF]
|
|
|
|
|
|
H. P. Brunner-La Rocca Interaction of Angiotensin-Converting Enzyme Inhibition and Aspirin in Congestive Heart Failure: Long Controversy Finally Resolved? Chest, October 1, 2003; 124(4): 1192 - 1194. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Huke, L. H Liu, D. Biniakiewicz, W. T Abraham, and M. Periasamy Altered force-frequency response in non-failing hearts with decreased SERCA pump-level Cardiovasc Res, September 1, 2003; 59(3): 668 - 677. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Schalcher, H. Rickli, M. Brehm, D. Weilenmann, E. Oechslin, W. Kiowski, and H. P. Brunner-La Rocca Prolonged Oxygen Uptake Kinetics During Low-Intensity Exercise Are Related to Poor Prognosis in Patients With Mild-to-Moderate Congestive Heart Failure Chest, August 1, 2003; 124(2): 580 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.A. v. Zwieten Drug Treatment of Congestive Heart Failure Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 13 - 17. [Abstract] [PDF]
|
|
|
|
|
|
P.R. Kalra, P.P. Ponikowski, and S.D. Anker Sympathetic activation and malignant ventricular arrhythmias: a molecular link? Eur. Heart J., July 2, 2002; 23(14): 1078 - 1080. [Full Text] [PDF]
|
|
|
|
|
|
G. Grassi, G. Seravalle, G. Bertinieri, M. L. Stella, C. Turri, and G. Mancia Sympathetic Response to Ventricular Extrasystolic Beats in Hypertension and Heart Failure Hypertension, April 1, 2002; 39(4): 886 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.J.S. Coats A sympathetic heart and the art of dying Eur. Heart J., July 1, 2001; 22(13): 1069 - 1071. [PDF]
|
|