© 2005 European Society of Cardiology
Decreased renal sympathetic activity in response to cardiac unloading with nitroglycerin in patients with heart failure
a Department of Cardiology, The Cardiovascular Institute, Sahlgrenska University Hospital S-413 45 Göteborg, Sweden
b Department of Clinical Physiology, Sahlgrenska University Hospital Göteborg, Sweden
c Baker Medical Research Institute Prahran, Australia
* Corresponding author. Tel.: +46 31 3424222; fax: +46 31 827614. E-mail address: magnus.petersson{at}wlab.gu.se
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Abstract |
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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.
Key Words: Heart failure • Congestive • Sympathetic nervous system • Renal circulation • Cardiovascular physiology • Baroreflex
Received July 30, 2004; Revised September 16, 2004; Accepted November 11, 2004
This study was supported by grants from the Swedish Heart Lung Foundation, The Sahlgrenska Academy at Göteborg University and Göteborg Medical Society. No conflict of interest exists.
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