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(Circulation. 1997;95:2130-2140.)
© 1997 American Heart Association, Inc.

Articles

Effects of Cardiac Denervation on Development of Heart Failure and Catecholamine Desensitization

Naoki Sato, MD; Stephen F. Vatner, MD; You-Tang Shen, MD; Raymond K. Kudej, DVM, PhD; Bijan Ghaleh-Marzban, PhD; Masami Uechi, DVM, PhD; Kuniya Asai, MD; Israel Mirsky, PhD; Thomas A. Patrick, BSE; Richard P. Shannon, MD; Dorothy E. Vatner, MD

From the New England Regional Primate Research Center (N.S., S.F.V., R.K.K., M.U., K.A., T.A.P.), Southborough, Mass; Allegheny University of the Health Sciences (S.F.V., R.K.K., K.A., T.A.P., R.P.S.), Pittsburgh, Pa; the Department of Medicine (S.F.V., R.K.K., D.E.V.), Harvard Medical School (N.S., S.F.V., Y.-T.S, R.K.K., B.G-M., M.U., K.A., I.M., T.A.P., D.E.V.), and Brigham & Women's Hospital (S.F.V., D.E.V.), Boston, Mass; and the Department of Pediatrics (D.E.V.), Massachusetts General Hospital, Boston.

Correspondence to Dorothy E. Vatner, MD, New England Regional Primate Research Center, One Pine Hill Dr, PO Box 9102, Southborough, MA 01772-9102.

Background Two signatures of heart failure are activation of the sympathetic nervous system and catecholamine desensitization. However, whether or not the elimination of cardiac nerves affects either the progression of heart failure or catecholamine desensitization is not clear.

Methods and Results We studied 8 dogs with selective ventricular denervation (VD) (surgical technique) and 10 intact dogs, chronically instrumented for measurement of left ventricular (LV) and arterial pressures, LV dP/dt, LV internal diameter, and wall thickness before and after heart failure was induced by rapid pacing (240 bpm) for 3 to 4 weeks. VD was confirmed by the absence of reflex effects induced by intracardiac veratrine and depletion of tissue norepinephrine and by supersensitive responses to norepinephrine. During the development of heart failure, LV end-systolic and end-diastolic stresses and heart rate increased, while myocardial contractility, as reflected by LV dP/dt and mean velocity of circumferential fiber shortening corrected for heart rate (Vcf_c), decreased in both intact and VD dogs. However, the increases in LV end-diastolic stress and decreases in LV dP/dt as well as the relationship between LV systolic stress and Vcf_c in heart failure were less (P<.05) in VD dogs. The responses of LV dP/dt and heart rate to both isoproterenol and norepinephrine in intact dogs were reduced in heart failure. The physiological desensitization to the inotropic effects of isoproterenol and norepinephrine was less in dogs with VD (P<.05), but chronotropic responses were similar because atrial innervation remained intact. Plasma norepinephrine levels were not different in VD dogs (592±79 pg/mL) compared with intact dogs (576±81 pg/mL) in heart failure.

Conclusions Dogs with selective VD tolerated the development of heart failure better than intact dogs and demonstrated significantly less catecholamine desensitization. The latter indicates that intact ventricular innervation is required for physiological expression of catecholamine desensitization despite comparable elevation of plasma catecholamines during the development of heart failure.

Key Words: ventricular denervation • catecholamines • receptors, beta, adrenergic • heart failure • physiology

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