Autonomic dysfunction is associated with cardiac remodelling in heart failure patients

Abstract

AimsOrthostatic hypotension (OH) is a cardinal sign of autonomic dysfunction and a common co‐morbidity in heart failure (HF). The role of autonomic dysfunction in the development of structural cardiac anomalies in HF patients has not been sufficiently explored. We aimed to assess relations between orthostatic blood pressure (BP) responses during active standing and echocardiographic changes in a series of patients admitted for HF.Methods and resultsOne hundred and forty‐nine patients hospitalized for HF [mean age: 74 years; 30% women; ejection fraction (LVEF) 40 ± 16%] were examined with conventional echocardiograms and active‐standing test. Associations of cardiac remodelling parameters with the difference between supine and standing (after 3 min) systolic/diastolic BP were examined. Systolic BP decreased (−1.1 ± 15 mmHg), whereas diastolic BP increased (+1.0 ± 9.5 mmHg) after 3 min of active standing. A total of 34 patients (23%) met conventional OH criteria; i.e. systolic/diastolic BP decreases by ≥20/10 mmHg. In the multivariable linear regression analysis, adjusted for traditional cardiovascular risk factors and LVEF, a decrease in systolic BP upon standing was associated with greater left atrial volume [β per −10 mmHg: 2.37, standard error (SE) = 1.16, P = 0.043], and greater left ventricular mass (β per −10 mmHg: 5.67, SE = 2.24, P = 0.012), but not with other echocardiographic parameters. No significant associations were observed between signs of cardiac remodelling and decrease in diastolic BP.ConclusionsOrthostatic decrease in systolic BP among older HF patients is associated with structural cardiac changes such as increased left atrial volume and left ventricular mass, independently of traditional risk factors and left ventricular dysfunction.

Cardiovascular biomarkers predict post‐discharge re‐hospitalization risk and mortality among Swedish heart failure patients

“…A total of 90 patients were re-hospitalized (median followup time, 5 months; IQR [1][2][3][4][5][6][7][8][9][10][11][12]) because of cardiac causes. The most common cardiac causes of re-hospitalization were HF (n = 79) followed by cardiac arrhythmia (n = 10) and myocardial infarction (n = 1).…”

“…The HeARt and Brain Failure inVESTigation project in Malmö, Sweden (HARVEST-Malmö), is an ongoing study undertaken in patients hospitalized for HF (ICD-10: I50-) in Skåne University Hospital, Malmö. 4,5 The inclusion criteria for the HARVEST study are admission to the Department of Cardiology or Internal Medicine for treatment of newly diagnosed or exacerbated HF. The only exclusion criterion is the inability to give informed consent.…”

Orthostatic hypotension and cardiovascular risk

“…65 Left ventricular hypertrophy and structural heart remodeling Orthostatic hypotension is a harbinger of structural and functional cardiac changes including left ventricular hypertrophy (LVH), diastolic dysfunction, and a reduction in right ventricular preload, independently of traditional risk factors among middle -aged adults. [68][69][70][71] Left ventricular hypertrophy in OH can be explained by: 1) pronounced diurnal BP variability and nocturnal hypertension; 2) arterial hypertension; and 3) upregulated neuroendocrine mechanisms leading to an increase of left ventricular mass through direct action on the myocardium or through their action on the vasculature.…”

Cardiovascular Safety Considerations in the Treatment of Neurogenic Orthostatic Hypotension

“…28 Although the mechanisms for cardiac remodeling associated with OH and nOH are uncertain, they may be related to blood pressure variability and supine hypertension. 15,16 The prognosis of patients with nOH due to an a-synucleinopathy is highly dependent on the underlying cause of autonomic failure, with the greatest mortality risk associated with a diagnosis of multiple system atrophy and the lowest for pure autonomic failure (Table 1). 10,11 In Parkinson disease populations, patients with OH have shorter survival than those without OH, indicating that the presence of cardiovascular autonomic dysfunction (e.g., nOH) may represent a more malignant subtype of Parkinson disease.…”