TY - JOUR
T1 - Sympathetic vasoconstrictor activity before and after left ventricular assist device implantation in patients with end-stage heart failure
AU - Heusser, Karsten
AU - Wittkoepper, Judith
AU - Bara, Christoph
AU - Haverich, Axel
AU - Diedrich, André
AU - Levine, Benjamin D.
AU - Schmitto, Jan D.
AU - Jordan, Jens
AU - Tank, Jens
N1 - Funding Information:
A.D. is supported by the National Heart, Lung, and Blood Institute of the National Health (Award Number NIH 1R01HL142583). K.H. and J.T. were supported by the German Federal Ministry of Economy and Technology (BMWi; 50WB1517).
Publisher Copyright:
© 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2021/11
Y1 - 2021/11
N2 - Aims: Sympathetic overactivity, which predicts poor outcome in patients with heart failure, normalizes following cardiac transplantation. We tested the hypothesis that haemodynamic improvement following left ventricular assist device (LVAD) implantation is also associated with reductions in centrally generated sympathetic activity. Methods and results: In eight patients with heart failure (two women, six men, age 44–66 years), we continuously recorded electrocardiogram, beat-to-beat finger blood pressure, respiration, and muscle sympathetic nerve activity (MSNA) before and after implantation of the continuous-flow LVAD devices HeartWare HVAD (n = 4) and HeartMate II (n = 2), and the non-continuous-flow device HeartMate 3 (n = 2). LVAD implantation increased cardiac output by 1.29 ± 0.88 L/min (P = 0.060) and mean arterial pressure by 16.2 ± 7.9 mmHg (P < 0.001), while reducing pulse pressure by 25.3 ± 9.8 mmHg (P < 0.001). LVAD implantation did not change MSNA burst frequency (−1.3 ± 7.5 bursts/min, P = 0.636), total activity (+0.62 ± 1.83 au, P = 0.369), or normalized activity (+0.63 ± 4.23, P = 0.685). MSNA burst incidence was decreased (−7.8 ± 9.3 bursts/100 heart beats, P = 0.049). However, cardiac ectopy altered MSNA bursting patterns that could be mistaken for sympatholysis. Conclusion: Implantation of current design LVAD does not consistently normalize sympathetic activity in patients with end-stage heart failure despite haemodynamic improvement.
AB - Aims: Sympathetic overactivity, which predicts poor outcome in patients with heart failure, normalizes following cardiac transplantation. We tested the hypothesis that haemodynamic improvement following left ventricular assist device (LVAD) implantation is also associated with reductions in centrally generated sympathetic activity. Methods and results: In eight patients with heart failure (two women, six men, age 44–66 years), we continuously recorded electrocardiogram, beat-to-beat finger blood pressure, respiration, and muscle sympathetic nerve activity (MSNA) before and after implantation of the continuous-flow LVAD devices HeartWare HVAD (n = 4) and HeartMate II (n = 2), and the non-continuous-flow device HeartMate 3 (n = 2). LVAD implantation increased cardiac output by 1.29 ± 0.88 L/min (P = 0.060) and mean arterial pressure by 16.2 ± 7.9 mmHg (P < 0.001), while reducing pulse pressure by 25.3 ± 9.8 mmHg (P < 0.001). LVAD implantation did not change MSNA burst frequency (−1.3 ± 7.5 bursts/min, P = 0.636), total activity (+0.62 ± 1.83 au, P = 0.369), or normalized activity (+0.63 ± 4.23, P = 0.685). MSNA burst incidence was decreased (−7.8 ± 9.3 bursts/100 heart beats, P = 0.049). However, cardiac ectopy altered MSNA bursting patterns that could be mistaken for sympatholysis. Conclusion: Implantation of current design LVAD does not consistently normalize sympathetic activity in patients with end-stage heart failure despite haemodynamic improvement.
KW - Baroreflex
KW - Heart failure
KW - Left ventricular assist device
KW - Microneurography
KW - Sympathetic nerve activity
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U2 - 10.1002/ejhf.2344
DO - 10.1002/ejhf.2344
M3 - Article
C2 - 34496114
AN - SCOPUS:85116354980
SN - 1388-9842
VL - 23
SP - 1955
EP - 1959
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 11
ER -