Faculty of Medicine, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, Debrecen, 4032, Hungary.
Faculty of Medicine, Department of Neurology, University of Debrecen, Debrecen, Hungary.
ESC Heart Fail. 2021 Dec;8(6):5112-5120. doi: 10.1002/ehf2.13580. Epub 2021 Sep 7.
While sympathetic overactivity in heart failure (HF) with reduced ejection fraction (HFrEF; EF < 40%) is well-documented, it is ill-defined in patients with mildly reduced EF (HFmrEF; EF 40-49%). Furthermore, the significance of ischaemic versus non-ischaemic aetiology in sympathetic activation is also unclear and has yet to be studied in HF. Our goal was to compare muscle sympathetic nerve activity (MSNA) in HFmrEF and HFrEF patients and in healthy subjects, as well as to elucidate the influence of the underlying disease.
Twenty-three HFrEF (age 58 ± 10 years), 33 HFmrEF patients (age 61 ± 10 years), including 11 subjects with non-ischaemic cardiomyopathy in each HF groups and 10 healthy controls (age 55 ± 10 years), were studied. MSNA-detected by peroneal microneurography, continuous arterial pressure, and ECG-was recorded. MSNA frequency (burst/min) and incidence (burst/100 cycles) were calculated. Association with the patients' characteristics were assessed, and aetiology-based comparisons were performed. Burst frequency demonstrated a significant stepwise increase in both HFmrEF (41 ± 11 burst/min) and HFrEF (58 ± 17 burst/min, P < 0.001) patients as compared with controls (27 ± 9; P < 0.001 for both HF groups). Similarly, burst incidences were 66 ± 17, 82 ± 15, and 36 ± 10 burst/100 cycles in HFmrEF, HFrEF patients, and in healthy controls, respectively (P < 0.001 for all). Burst frequencies in HF patients showed significant correlation with NT-proBNP levels, and significant inverse correlations with the subjects' mean RR intervals, stroke volumes, pulse pressures, and EF.
Muscle sympathetic nerve activity parameters indicated significant sympathetic activation in both HFmrEF and HFrEF patients as compared with healthy controls with no difference in relation to ischaemic versus non-ischaemic aetiology.
虽然心力衰竭（HF）伴射血分数降低（HFrEF；EF<40%）时交感神经过度活跃已有充分记录，但 EF 轻度降低（HFmrEF；EF 40-49%）的患者中这种情况仍不明确。此外，交感神经激活中缺血性与非缺血性病因的意义也不清楚，并且在 HF 中尚未进行研究。我们的目标是比较 HFmrEF 和 HFrEF 患者与健康受试者的肌肉交感神经活动（MSNA），并阐明潜在疾病的影响。
研究了 23 例 HFrEF 患者（年龄 58±10 岁）、33 例 HFmrEF 患者（年龄 61±10 岁），包括每个 HF 组中的 11 例非缺血性心肌病患者和 10 例健康对照者（年龄 55±10 岁）。通过腓肠神经微神经记录、连续动脉压和心电图记录 MSNA。计算 MSNA 频率（爆发/分钟）和发生率（爆发/100 个周期）。评估与患者特征的相关性，并进行病因学比较。与对照组相比，HFmrEF（41±11 次爆发/分钟）和 HFrEF（58±17 次爆发/分钟，P<0.001）患者的爆发频率均显著递增（P<0.001）。同样，HFmrEF、HFrEF 患者和健康对照组的爆发发生率分别为 66±17、82±15 和 36±10 次/100 个周期（所有组均 P<0.001）。HF 患者的爆发频率与 NT-proBNP 水平显著相关，与受试者平均 RR 间期、心排量、脉压和 EF 呈显著负相关。
与健康对照组相比，HFmrEF 和 HFrEF 患者的 MSNA 参数均表明存在显著的交感神经激活，且与缺血性与非缺血性病因无关。
