This Article Full Text Full Text (PDF) All Versions of this Article: 49/3/535    most recent 01.HYP.0000255983.32896.b9v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grassi, G. Articles by Mancia, G. Search for Related Content PubMed PubMed Citation Articles by Grassi, G. Articles by Mancia, G. Related Collections Congestive Lipids Obesity Clinical Studies

(Hypertension. 2007;49:535.)
© 2007 American Heart Association, Inc.

Original Articles

Excessive Sympathetic Activation in Heart Failure With Obesity and Metabolic Syndrome

Characteristics and Mechanisms

Guido Grassi; Gino Seravalle; Fosca Quarti-Trevano; Francesco Scopelliti; Raffaella Dell’Oro; Gianbattista Bolla; Giuseppe Mancia

From the Clinica Medica, Dipartimento di Medicina Clinica (G.G., F.Q.-T., F.S., R.D., G.M.), Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Milan, Italy; Istituto Auxologico Italiano (G.G., G.S., G.M.), Milan, Italy; and Centro Interuniversitario di Fisiologia Clinica e Ipertensione (G.G., G.B., G.M.), Milan, Italy.

Correspondence to Guido Grassi, Clinica Medica, Ospedale San Gerardo dei Tintori, Via Pergolesi 33, 20052 Milan, Italy. E-mail guido.grassi{at}unimib.it

Congestive heart failure is characterized by sympathetic activation, which has also been described in the metabolic syndrome. No information exists, however, as to whether the sympathostimulating effects of these 2 conditions summate when heart failure is complicated by the metabolic syndrome, leading to an exceedingly high adrenergic drive. This is clinically relevant, because in heart failure sympathetic activation is closely related to mortality. We studied 48 control subjects (age: 58.4±1.6 years, mean±SEM) and 89 age-matched heart failure patients (New York Heart Association class II), of whom 47 were without and 42 were with metabolic syndrome. Measurements included blood pressure (Finapres), heart rate (ECG), and sympathetic nerve traffic (microneurography) at rest and during baroreceptor manipulation. Waist circumference, blood pressure, and metabolic variables were greater in heart failure with metabolic syndrome than in heart failure without metabolic syndrome and in control subjects. Left ventricular ejection fraction and end-diastolic diameter were similarly altered in the 2 heart failure groups. Compared with control subjects, sympathetic nerve activity was greater in heart failure patients without metabolic syndrome (64.7±3.2 versus 45.8±2.9 bursts/100 heartbeats; P<0.01), a further pronounced increase being detected in those with metabolic syndrome (80.9±3.2 bursts/100 heartbeats; P<0.01). In the multivariate analysis, waist circumference and body mass index were the variables most closely related to sympathetic activation. Compared with control subjects, baroreflex responses were significantly attenuated in the 2 heart failure groups, the impairment being more marked in the group with than without metabolic syndrome. Thus, obesity and metabolic syndrome potentiate the sympathetic activation characterizing heart failure. This potentiation is likely to mainly depend on metabolic and baroreflex mechanisms.

Key Words: baroreflex • metabolic syndrome • heart failure • sympathetic nervous system

This article has been cited by other articles:

				G. Grassi Assessment of Sympathetic Cardiovascular Drive in Human Hypertension: Achievements and Perspectives Hypertension, October 1, 2009; 54(4): 690 - 697. [Abstract] [Full Text] [PDF]

				G. Hu, E. A. Oboukhova, S. Kumar, M. Sturek, and A. G. Obukhov Canonical Transient Receptor Potential Channels Expression Is Elevated in a Porcine Model of Metabolic Syndrome Mol. Endocrinol., May 1, 2009; 23(5): 689 - 699. [Abstract] [Full Text] [PDF]

				R. P. Vivo, S. R. Krim, C. Cevik, and R. M. Witteles Heart failure in hispanics. J. Am. Coll. Cardiol., April 7, 2009; 53(14): 1167 - 1175. [Abstract] [Full Text] [PDF]

				G. Grassi, G. Bolla, F. Quarti-Trevano, F. Arenare, G. Brambilla, and G. Mancia Sympathetic activation in congestive heart failure: Reproducibility of neuroadrenergic markers Eur J Heart Fail, December 1, 2008; 10(12): 1186 - 1191. [Abstract] [Full Text] [PDF]

				Y. B. Sverrisdottir, T. Mogren, J. Kataoka, P. O. Janson, and E. Stener-Victorin Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth? Am J Physiol Endocrinol Metab, March 1, 2008; 294(3): E576 - E581. [Abstract] [Full Text] [PDF]

				L. F. Drager, E. M. Krieger, and G. Lorenzi-Filho Sympathetic Activity, Heart Failure, Obesity, and Metabolic Syndrome: Is There Any Role for Obstructive Sleep Apnea? Hypertension, June 1, 2007; 49(6): e38 - e38. [Full Text] [PDF]

				G. Grassi, G. Seravalle, F. Q. Trevano, F. Scopelliti, R. Dell'Oro, G. Bolla, and G. Mancia Response to Sympathetic Activity, Heart Failure, Obesity, and Metabolic Syndrome: Is There Any Role for Sleep Apnea? Hypertension, June 1, 2007; 49(6): e39 - e39. [Full Text] [PDF]