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Increased muscle sympathetic nerve activity predicts mortality in heart failure patients.
MedLine Citation:
PMID:  18582965     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Previous studies have associated neurohumoral excitation, as estimated by plasma norepinephrine levels, with increased mortality in heart failure. However, the prognostic value of neurovascular interplay in heart failure (HF) is unknown. We tested the hypothesis that the muscle sympathetic nerve activity (MSNA) and forearm blood flow would predict mortality in chronic heart failure patients. METHODS: One hundred and twenty two heart failure patients, NYHA II-IV, age 50+/-1 ys, LVEF 33+/-1%, and LVDD 7.1+/-0.2 mm, were followed up for one year. MSNA was directly measured from the peroneal nerve by microneurography. Forearm blood flow was obtained by venous occlusion plethysmography. The variables were analyzed by using univariate, stepwise multivariate Cox proportional hazards analysis, and Kaplan-Meier analysis. RESULTS: After one year, 34 pts died from cardiac death. The univariate analysis showed that MSNA, forearm blood flow, LVDD, LVEF, and heart rate were significant predictors of mortality. The multivariate analysis showed that only MSNA (P=0.001) and forearm blood flow (P=0.003) were significant independent predictors of mortality. On the basis of median levels of MSNA, survival rate was significantly lower in pts with >49 bursts/min. Similarly, survival rate was significantly lower in pts with forearm blood flow <1.87 ml/min/100 ml (P=0.002). CONCLUSION: MSNA and forearm blood flow predict mortality rate in patients with heart failure. It remains unknown whether therapies that specifically target these abnormalities will improve survival in heart failure.
Authors:
Antonio C P Barretto; Amilton C Santos; Robinson Munhoz; Maria U P B Rondon; Fábio G Franco; Ivani C Trombetta; Fabiana Roveda; Luciana N J de Matos; Ana M W Braga; Holly R Middlekauff; Carlos E Negrão
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-26
Journal Detail:
Title:  International journal of cardiology     Volume:  135     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  302-7     Citation Subset:  IM    
Affiliation:
Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil.
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