Autonomic nervous system dysfunction in advanced systolic heart failure

Sánchez‐Lázaro, Ignacio; Cano, Óscar; Ruiz-Llorca, C.; Almenar‐Bonet, Luis; Sancho‐Tello, María; Martínez‐Dolz, Luis; Navarro-Mateo, Antonio; Sanz, Antonio Salvador

doi:10.1016/j.ijcard.2010.07.010

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…To date, the prognostic value of BRS and HRV testing was unambiguously confirmed solely with regards to malignant ventricular arrhythmias, sudden cardiac death and cardiac mortality [ 14 , 19 – 23 ]. Although a number of authors documented alterations of these parameters in individuals with heart failure [ 1 – 3 , 7 , 23 , 24 ], the data on the prognostic value of BRS and HRV as potential predictors of heart failure decompensation in clinically stable patients with LV systolic dysfunction, treated according to current guidelines, are sparse. One study showed that baseline HRV may be useful in identifying patients being at increased risk of hospitalization due to late-onset heart failure after acute myocardial infarction [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to literature, patients with heart failure are characterized by predominance of sympathetic activity and decreased vagal tone [ 1 – 3 ]. Baroreflex sensitivity (BRS) and heart rate variability (HRV), reliable measures of autonomic nervous system (ANS) balance [ 4 – 6 ], frequently referred to as sudden cardiac death risk parameters, can be significantly deranged during acute phase of heart failure exacerbation [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Daniłowicz‐Szymanowicz

Suchecka

Niemirycz-Makurat

et al. 2016

PLoS ONE

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IntroductionAutonomic nervous system balance can be significantly deteriorated during heart failure exacerbation. However, it is still unknown whether these changes are only the consequence of heart failure decompensation or can also predict development thereof. Objectives were to verify if simple, non-invasive autonomic parameters, such as baroreflex sensitivity and short-term heart rate variability can provide independent of other well-known clinical parameters information on the risk of heart failure decompensation in patients with left ventricular systolic dysfunction.MethodsIn 142 stable patients with left ventricular ejection fraction ≤ 40%, baroreflex sensitivity and short-term heart rate variability, as well as other well-known clinical parameters, were analyzed. During 23 ± 9 months of follow-up 19 patients were hospitalized due to the heart failure decompensation (EVENT).ResultsPre-specified cut-off values of baroreflex sensitivity (≤2.4 ms/mmHg) and low frequency power index of heart rate variability (≤19 ms2) were significantly associated with the EVENTs (hazard ratio 4.43, 95% confidence interval [CI] 1.35–14.54 and 5.41, 95% CI 1.87–15.65 respectively). EVENTs were also associated with other parameters, such as left ventricular ejection fraction, NYHA class, diuretic use, renal function, brain natriuretic peptide and hemoglobin level, left atrial size, left and right ventricular heart failure signs. After adjusting baroreflex sensitivity and low frequency power index for each of the abovementioned parameters, autonomic parameters were still significant predictors of hospitalization due to the heart failure decompensation.ConclusionSimple, noninvasive autonomic indices can be helpful in identifying individuals with increased risk of hospitalization due to the heart failure decompensation among clinically stable patients with left ventricular systolic dysfunction, even when adjusted for other well-known clinical parameters.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Daniłowicz‐Szymanowicz

Suchecka

Niemirycz-Makurat

et al. 2016

PLoS ONE

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“…Historically, because of a delayed national consensus on this treatment and because there are few donors, Japan has much less experience with heart transplantation per se than other countries and, therefore, has no significant clinical data on cardiac 123 I-MIBG imaging for this treatment. Nevertheless, compared with other, standard parameters, cardiac 123 I-MIBG imaging may contribute to improvements in determining the necessity of heart transplantation and expected survival interval (3,12,68,69) in an era when advanced device therapy, optimal drug treatment, and cardiac 123 I-MIBG imaging are available. Cardiac 123 I-MIBG imaging may be also useful for the assessment of reinnervation in transplanted hearts.…”

Section: Cardiac 123 I-mibg Imaging In Heart Transplantationmentioning

confidence: 99%

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Nakajima

Nakata

2015

J Nucl Med

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Cardiac neuroimaging with 123 I-metaiodobenzylguanidine ( 123 I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac 123 I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of 123 I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac 123 I-MIBG parameter, the heartto-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6−1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on 123 I-MIBG studies had a good long-term prognosis. Future investigations of cardiac 123 I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of costeffective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice.

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“…Sánchez‐Lázaro et al. concluded that in stable patients with advanced heart failure, both sympathetic and parasympathetic autonomic nervous systems can be affected . Therefore, as the presence of cardiovascular autonomic neuropathy may have profound effects and complicate postoperative recovery, its diagnosis is essential as part of the assessment of risk.…”

Section: Cardiovascular Complicationsmentioning

confidence: 99%

The impact of autonomic dysfunction on peri‐operative cardiovascular complications

et al. 2014

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SummaryCardiovascular autonomic neuropathy is frequently observed in patients with diabetes mellitus. As anaesthesia has a marked effect on peri-operative autonomic function, the interplay between diabetic neuropathy and anaesthesia may result in unexpected haemodynamic instability during surgery. The objective of this literature review was to examine the association of cardiovascular autonomic neuropathy with peri-operative cardiovascular complications. We searched PubMed for articles with search elements of autonomic dysfunction [MeSH] AND anaesthesia [MeSH] AND complications [MeSH]. Depending on the type of anaesthesia, the presence of cardiovascular autonomic neuropathy in surgical patients can markedly affect peri-operative haemodynamics and postoperative recovery. Preoperative testing of the extent of autonomic dysfunction in particular populations, like diabetics, may contribute to a reduction in haemodynamic instability and cardiovascular complications. Non-invasive diagnostic methods assessing autonomic function may be an important tool during pre-operative risk assessment.

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Autonomic nervous system dysfunction in advanced systolic heart failure

Cited by 8 publications

References 25 publications

Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

The impact of autonomic dysfunction on peri‐operative cardiovascular complications

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Autonomic nervous system dysfunction in advanced systolic heart failure

Cited by 8 publications

References 25 publications

Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

The impact of autonomic dysfunction on peri‐operative cardiovascular complications

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Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan