Cardiac and peripheral autonomic control in restrictive cardiomyopathy

Author(s):Show less -

Sayegh, Ana Luiza C. ^[1] ; dos Santos, Marcelo R. ^[2] ; Sarmento, Adriana O. ^[2] ; de Souza, Francis R. ^[2] ; Salemi, Vera M. C. ^[3] ; Hotta, Viviane T. ^[1] ; Marques, Akothirene Cristhina D. B. ^[2] ; Kramer, Heidrum H. ^[4] ; Trombetta, Ivani C. ^[2] ; Mady, Charles ^[1] ; Nunes Alves, Maria Janieire de Nazare ^[2]

Affiliation

^[1] Univ Sao Paulo, Sch Med, Heart Inst InCor, Clin Unit Cardiomyopathy, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Heart Inst InCor, Cardiovasc Rehabil & Exercise Physiol Unit, Ave Dr Eneas de Carvalho Aguiar 44, BR-05403000 Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Sch Med, Heart Inst InCor, Clin Unit Heart Failure, Sao Paulo - Brazil

^[4] Justus Liebig Univ, Dept Neurol, Giessen - Germany

• Document type: Journal article
• Source: ESC HEART FAILURE; v. 4, n. 3, p. 341-350, AUG 2017.
• Web of Science Citations: 0

Abstract

Aims Autonomic dysfunction determines the advance of dilated cardiomyopathy (DCM) and is related to poor outcomes. However, this autonomic imbalance is unknown in patients with restrictive cardiomyopathy (RCM) even though they have similar symptoms and poor quality of life as DCM patients have. The aim of this study was to evaluate if autonomic and neurovascular controls were altered in RCM patients. Methods and results Fifteen RCM patients, 10 DCM patients, and 10 healthy subjects were evaluated. Heart rate and blood pressure (BP) were recorded. Peripheral sympathetic activity {[}muscle sympathetic nerve activity (MSNA)] by microneurography and cardiac sympathetic activity by power spectrum analysis of heart rate variability. Spontaneous baroreflex sensitivity (BRS) was evaluated by the sequence method and forearm blood flow by venous occlusion plethysmography. Both cardiomyopathy groups had higher MSNA frequency (P < 0.001) and MSNA incidence (P < 0.001), higher cardiac sympathovagal balance (P < 0.02), reduced BRS for increase (P = 0.002) and for decrease in BP (P = 0.002), and lower forearm blood flow (P < 0.001) compared with healthy subjects. We found an inverse correlation between BRS for increase and decrease in BP and peripheral sympathetic activity (r = -0.609, P = 0.001 and r = -0.648, P < 0.001, respectively) and between BRS for increase and decrease in BP and cardiac sympathetic activity (r = -0.503, P = 0.03 and r = -0.487, P = 0.04, respectively). Conclusions The RCM patients had cardiac and peripheral autonomic dysfunctions associated with peripheral vasoconstriction. Nonetheless, the presence of normal ejection fraction underestimates the evolution of the disease and makes clinical treatment difficult. These alterations could lead to a similar cardiovascular risk as that observed in DCM patients. (AU)

• FAPESP's process: 09/17529-9 - The cardiac rehabilitation in patients undergoing Endomyocardial Fibrosis in heart failure class II and III
• Grantee: Charles Mady
• Support Opportunities: Regular Research Grants