The Role of the Autonomic Nervous System in Congestive Heart Failure
Altered sympathovagal balance could be a substrate for malignant ventricular arrhythmias in congestive heart failure. The aim of this study is to assess neuroautonomic function by power spectral analysis in patients with congestive heart failure and the effects of treatment with Carvedilol in these patients. We compared the LF/HF ratio of all patients at baseline and after sympathetic stress (tilt). In group I, we considered 10 patients with congestive heart failure and 10 controls mean aged 60 years, while in group II were 10 patients with heart failure 70 years old and normal subjects age-matched. In group I, at rest the subjects with congestive heart failure had a significantly greater LF/HF (p<0.001) than controls. In contrast, it increased significantly after tilt in control subjects. In group II, at rest LF/HF did not differ between patients with congestive heart failure and normal subjects, while after tilt it resulted higher in controls (p<0.05). After a month of 25 mg daily of Carvedilol administration in patients with heart failure in group I, both at rest and after tilt, LF/HF was significantly greater in patients in wash-out than treated (p<0.001). In group II there weren’t significant differences both at rest and after tilt. This study showed increase of sympathetic activity in patients with congestive heart failure mean aged 60 years, less evident in patients aged 70 years. Carvedilol can exert beneficial myocardial effects in these patients, because reduces morbidity and mortality and can favorably influence the course of disease and prolong survival.
KeywordsHeart Failure Congestive Heart Failure Chronic Heart Failure Idiopathic Dilate Cardiomyopathy Power Spectral Analysis
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- 10.Pomeranz B, Macaulay RJB, Caudill MA, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ, Benson H. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Phisiol 1985; 248: H151–H153.Google Scholar
- 11.Yo Y, Nagano N, Iiyama K, Higaki J, Mikami H, Ogihara T. Effects of age and hypertension on autonomic nervous regulation during passive head-up tilt. Hypertension 1994; 23 (supp I): 1–82–1–86.Google Scholar
- 12.Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, Sandrone G, Malfatto G, DellOrto G, Piccaluga E, Tureil M, Baselli G, Cerutti S, Malliani A. Power spectral analysis of heart rate and arterial pressure variability as a marker of sympathovagal interaction in man and conscious dog. Circ. Res. 1986; 59: 178–193.PubMedCrossRefGoogle Scholar
- 13.Ripley KL, Murray A. Introduction to automated arrhythmia detection. New York TEEE Comp. Society Press, 1980.Google Scholar
- 21.Saul JP, Albrecht P, Berger RD, Cohen RJ. Analysis of long term heart rate variability: methods, scaling and implications. IEEE 1988; 88: 409–412.Google Scholar
- 23.Gottdiener JS, Reda DJ, Matterson BJ, Massie BM, Notargiacomo A, Hamburger RJ, Williams DW, Henderson WG. Importance of obesity, race and age to the cardiac structural and functional effects of hypertension. J Am Coll Cardiol 1994; 24: 1992–1498.Google Scholar
- 24.Brovelli M, Baselli, Cerutti S. Computerized analysis for an experimental validation of neurophysiological models of heart rate control. In Computers in Cardiology. Silver Spring Md, IEEE Computer Society Press 1983:205-208.Google Scholar
- 27.Feldman AM, Bristow MR. Adrenergic neuroeffector mechanisms in the failing human heart. In: Braunwald E, ed. Clinical Update, 3rd ed. Heart disease. Philadelphia: W.B. Saunders, 1990: 206–216.Google Scholar
- 32.Das Gupta P, Broadhurst P, Lahiri A. The effects of intravenous Carvedilol, a new multiple action vasodilating beta-blocker, in congestive heart failure. J Cardiovascul Pharmacol 1991; 18 (suppl.4): S12–S16.Google Scholar
- 33.Olsen SL, Gilbert EM, Renlund DG, Mealey PC, Volkman K, O’Connel JB, Yanowitz FD, Bristow MR. Carvedilol improves left ventricular function in idiopathic dilated cardiomyopathy. Circulation 1991; 84: II–564.Google Scholar
- 34.Olsen SL, Gilbert EM, Renlund DG, Mealey PC, Taylor DO, Volkman AK, Bristow MR Carvedilol improves symptoms and left ventricular function in patients with congestive heart failure due to ischemic or idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1993; 21: 11A.Google Scholar