Lower rotation speed stimulates sympathetic activation during continuous-flow left ventricular assist device treatment

被引:8
作者
Imamura, Teruhiko [1 ]
Kinugawa, Koichiro [1 ]
Nitta, Daisuke [2 ]
Fujino, Takeo [2 ]
Inaba, Toshiro [2 ]
Maki, Hisataka [2 ]
Hatano, Masaru [2 ]
Kinoshita, Osamu [3 ]
Nawata, Kan [3 ]
Kyo, Shunei [1 ]
Ono, Minoru [3 ]
机构
[1] Univ Tokyo, Grad Sch Med, Dept Therapeut Strategy Heart Failure, Bunkyo Ku, Tokyo 1138655, Japan
[2] Univ Tokyo, Grad Sch Med, Dept Cardiovasc Med, Tokyo 1138655, Japan
[3] Univ Tokyo, Grad Sch Med, Dept Cardiac Surg, Tokyo 1138655, Japan
关键词
Heart failure; Autonomic nerve; Heart rate variability; Reverse remodeling; HEART-FAILURE; CARVEDILOL; PROGNOSIS;
D O I
10.1007/s10047-014-0800-2
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Although the suppression of sympathetic activity is an essential mission for the current heart failure treatment strategy, little is known about the relationship between the rotation speed setting and autonomic nervous activity during continuous-flow left ventricular assist device (LVAD) treatment. We evaluated 23 adult patients with sinus rhythm (36 +/- A 13 years) who had received continuous-flow LVAD and been followed at our institute between March 2013 and August 2014. Heart rate variability measurement was executed along with hemodynamic study at 3 rotation speeds (low, middle, and high) at 5 weeks after LVAD implantation. Lower rotation speed was associated with higher ratio of low-frequency over high-frequency spectral level (LF/HF), representing enhanced sympathetic activation (p < 0.05 by repeated analyses of variance). Among hemodynamic parameters, cardiac index was exclusively associated with LFNU = LF/(LF + HF), representing relative sympathetic activity over parasympathetic one (p < 0.05). After 6 months LVAD support at middle rotation speed, 19 patients with higher LFNU eventually had higher plasma levels of B-type natriuretic peptide and achieved less LV reverse remodeling. A logistic regression analysis demonstrated that lower LFNU was significantly associated with improvement of LV reverse remodeling (p = 0.021, odds ratio 0.903) with a cut-off level of 55 % calculated by the ROC analysis (AUC 0.869). In conclusion, autonomic activity can vary in various rotation speeds. Patients with higher LFNU may better be controlled at higher rotation speed with the view point to suppress sympathetic activity and achieve LV reverse remodeling.
引用
收藏
页码:20 / 26
页数:7
相关论文
共 20 条
[1]   POWER SPECTRUM ANALYSIS OF HEART-RATE FLUCTUATION - A QUANTITATIVE PROBE OF BEAT-TO-BEAT CARDIOVASCULAR CONTROL [J].
AKSELROD, S ;
GORDON, D ;
UBEL, FA ;
SHANNON, DC ;
BARGER, AC ;
COHEN, RJ .
SCIENCE, 1981, 213 (4504) :220-222
[2]   Mechanism of action of beta-blocking agents in heart failure [J].
Bristow, MR .
AMERICAN JOURNAL OF CARDIOLOGY, 1997, 80 (11A) :L26-L40
[3]  
Camm AJ, 1996, EUR HEART J, V17, P354
[4]   PLASMA NOREPINEPHRINE AS A GUIDE TO PROGNOSIS IN PATIENTS WITH CHRONIC CONGESTIVE HEART-FAILURE [J].
COHN, JN ;
LEVINE, TB ;
OLIVARI, MT ;
GARBERG, V ;
LURA, D ;
FRANCIS, GS ;
SIMON, AB ;
RECTOR, T .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 311 (13) :819-823
[5]   Medical therapy can improve the biological properties of the chronically failing heart - A new era in the treatment of heart failure [J].
Eichhorn, EJ ;
Bristow, MR .
CIRCULATION, 1996, 94 (09) :2285-2296
[6]   Sympathetic activation in human heart failure: diverse mechanisms, therapeutic opportunities [J].
Floras, JS .
ACTA PHYSIOLOGICA SCANDINAVICA, 2003, 177 (03) :391-398
[7]   STUDIES ON STARLINGS LAW OF THE HEART .1. THE CIRCULATORY RESPONSE TO ACUTE HYPERVOLEMIA AND ITS MODIFICATION BY GANGLIONIC BLOCKADE [J].
FRYE, RL ;
BRAUNWALD, E .
JOURNAL OF CLINICAL INVESTIGATION, 1960, 39 (07) :1043-1050
[8]   The effect of long-term left ventricular assist device support on myocardial sympathetic activity in patients with non-ischaemic dilated cardiomyopathy [J].
George, Robert S. ;
Birks, Emma J. ;
Cheetham, Andrew ;
Webb, Carole ;
Smolenski, Ryszad T. ;
Khaghani, Asghar ;
Yacoub, Magdi H. ;
Kelion, Andrew .
EUROPEAN JOURNAL OF HEART FAILURE, 2013, 15 (09) :1035-1043
[9]   Efficacy and safety of bisoprolol fumarate compared with carvedilol in Japanese patients with chronic heart failure: results of the randomized, controlled, double-blind, Multistep Administration of bisoprolol IN Chronic Heart Failure II (MAIN-CHF II) study [J].
Hori, Masatsugu ;
Nagai, Ryozo ;
Izumi, Tohru ;
Matsuzaki, Masunori .
HEART AND VESSELS, 2014, 29 (02) :238-247
[10]   Low Cardiac Output Stimulates Vasopressin Release in Patients With Stage D Heart Failure - Its Relevance to Poor Prognosis and Reversal by Surgical Treatment [J].
Imamura, Teruhiko ;
Kinugawa, Koichiro ;
Hatano, Masaru ;
Fujino, Takeo ;
Inaba, Toshiro ;
Maki, Hisataka ;
Kinoshita, Osamu ;
Nawata, Kan ;
Kyo, Shunei ;
Ono, Minoru ;
Komuro, Issei .
CIRCULATION JOURNAL, 2014, 78 (09) :2259-2267