Decreased renal sympathetic activity in response to cardiac unloading with nitroglycerin in patients with heart failure

• AIMS: To examine changes in renal sympathetic outflow in response to cardiac unloading with nitroglycerin (GTN) in patients with chronic heart failure (CHF) and healthy subjects (HS). METHODS AND RESULTS: Renal (RNAsp) and total body (TBNAsp) noradrenaline (NA) spillover were measured with radiotracer methods in 16 patients with CHF (50+/-3 years, LVEF 20+/-1%) and nine HS (57+/-2 years) during right heart and renal vein catheterisation. Low dose GTN decreased mean pulmonary artery pressure (PAm: CHF -7+/-2 mm Hg, HS -4+/-1 mm Hg, p<0.05 vs. baseline) but not mean arterial pressure (MAP: CHF -2+/-1 mm Hg, HS -2+/-1 mm Hg) and did not affect RNAsp in any of the study groups. High dose GTN lowered MAP (CHF -12+/-1 mm Hg, HS -12+/-2 mm Hg, p<0.05 vs. baseline) and PAm (CHF -13+/-2 mm Hg, HS -5+/-1 mm Hg, p<0.05 vs. baseline) and was accompanied by a significant reduction in RNAsp only in CHF (1.3+/-0.1 nmol/min baseline to 0.9+/-0.2 nmol/min, p<0.05), whereas RNAsp in HS remained unchanged. CONCLUSIONS: In spite of a reduction in both arterial pressure and cardiac filling pressures, renal sympathetic activity decreased in CHF and did not increase in HS. These findings suggest that the altered loading conditions resulting from high-dose GTN infusion have renal sympathoinhibitory effects.

Nyckelord

Analysis of Variance

Case-Control Studies

Dose-Response Relationship

Drug

Female

Follow-Up Studies

Heart Catheterization

Heart Failure

Congestive/*diagnosis/*drug therapy

Hemodynamic Processes/physiology

Humans

Infusions

Intravenous

Kidney/drug effects/*radionuclide imaging

Kidney Function Tests

Male

Middle Aged

Nitroglycerin/*pharmacokinetics/therapeutic use

Probability

Reference Values

Renal Circulation/drug effects/physiology

Risk Assessment

Severity of Illness Index

Statistics

Nonparametric

Sympathetic Nervous System/*drug effects

Ventricular Dysfunction

Left/diagnosis/drug therapy

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)