Circulation, Vol 90, 1794-1798, Copyright © 1994 by American Heart Association
HR Middlekauff, MA Hamilton, LW Stevenson and AL Mark
BACKGROUND: Sympathetic excitation characterizes heart failure, but the
underlying mechanisms remain unknown. Abnormal baroreflex restraint of
sympathetic neural outflow has been proposed, since baroreflexes are known
to be abnormal in heart failure. The purpose of this study was to determine
if sympathetic activation in humans with heart failure is limited to
regions governed by the baroreflexes or is generalized to other regions
free from baroreflex control. METHODS AND RESULTS: We report the first
direct recordings of skin sympathetic nerve activity (free from baroreflex
control) in humans with heart failure and compare simultaneous skin and
muscle (baroreflex-dependent) sympathetic peroneal nerve activity in six
patients with severe heart failure (mean left ventricular ejection
fraction, 0.19 +/- 0.06) and in six age- matched normal control subjects.
Although muscle sympathetic nerve activity was markedly increased in heart
failure patients (heart failure versus controls, 69 +/- 3 versus 21 +/- 2
bursts per minute; P < .001), skin sympathetic nerve activity was not
increased (heart failure versus controls, 12 +/- 1 versus 15 +/- 1 bursts
per minute; P = NS). CONCLUSIONS: The finding that skin sympathetic nerve
activity in contrast to muscle sympathetic nerve activity is not increased
in heart failure supports the concept that an altered reflex system, such
as the baroreflexes, with nonuniform effects on muscle and skin sympathetic
nerve activity, underlies sympatho-excitation in heart failure.
ARTICLES
Independent control of skin and muscle sympathetic nerve activity in patients with heart failure
Division of Cardiology, University of California, Los Angeles 90024.
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