Apparent paradox of neurohumoral axis inhibition after body fluid volume depletion in patients with chronic congestive heart failure and water retention
Articolo
Data di Pubblicazione:
1994
Citazione:
Apparent paradox of neurohumoral axis inhibition after body fluid volume depletion in patients with chronic congestive heart failure and water retention / M.D. Guazzi, P. Agostoni, B. Perego, G. Lauri, A. Salvioni, F. Giraldi, M. Matturri, M. Guazzi, G. Marenzi. - In: BRITISH HEART JOURNAL. - ISSN 0007-0769. - 72:6(1994 Dec), pp. 534-539.
Abstract:
Background-Hypovolaemia stimulates
the sympathoadrenal and renin systems
and water retention. It has been proposed
that in congestive heart failure reduction
of cardiac output and any associated
decrease in blood pressure cause underfilling
ofthe arterial compartment, which
promotes and perpetuates neurohumoral
activation and the retention of fluid. This
study examined whether an intravascular
volume deficit accounts for patterns that
largely exceed the limits ofa homoeostatic
response, which are sometimes seen in
advanced congestive heart failure.
Methods and Results-In 22 patients with
congestive heart failure and water retention
the body fluid mass was reduced by
ultraffitration and the neurohumoral
reaction was monitored. A Diafilter,
which was part of an external venous
circuit was regulated to produce 500
ml/hour of ultrafiltrate (mean (SD) 3122
(1199) ml) until right atrial pressure was
reduced to 50% of baseline. Haemodynamic
variables, plasma renin activity,
noradrenaline, and aldosterone were
measured before and within 48 hours of
ultrafiltration. After ultraflitration,
which produced a 20% reduction of
plasma volume and a moderate decrease
in cardiac output and blood pressure
(consistent with a diminished degree of
filling of the arterial compartment),
there was an obvious decrease in noradrenaline,
plasma renin activity, and
aldosterone. In the next 48 hours plasma
volume, cardiac output, and blood pressure
recovered; the neurohumoral axis
was depressed; and there was a striking
enhancement of water and sodium excretion
with resolution of the peripheral
oedema and organ congestion. The neurohumoral
changes and haemodynamic
changes were not related. There were significant
correlations between the neurohumoral
changes and increase in urinary
output and sodium excretion.
Conclusions-In advanced congestive
heart failure arterial underfilling was not
the main mechanism for activating the
neurohumoral axis and retaining fluid.
Because a decrease in circulating hormones
was associated with reabsorption
of extravascular fluid it is likely that
hypoperfusion and/or congestion of
organs, such as the kidney and lung,
reduce the clearance of circulating noradrenaline
and help to keep plasma concentrations
of renin and aldosterone
raised. A positive feedback loop between
fluid retention and plasma hormone concentrations
may be responsible for pprogression
of congestive heart failure.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Renin; Body Fluids; Neurotransmitter Agents; Heart Failure; Plasma Volume; Humans; Hemofiltration; Aged; Sodium; Norepinephrine; Kidney; Hematocrit; Middle Aged; Feedback; Follow-Up Studies; Aldosterone; Body Water; Female; Male; Stroke Volume
Elenco autori:
M.D. Guazzi, P. Agostoni, B. Perego, G. Lauri, A. Salvioni, F. Giraldi, M. Matturri, M. Guazzi, G. Marenzi
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