Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity.
Abstract
The analysis of plasma kinetics of the sympathetic neurotransmitter norepinephrine can be used to estimate sympathetic nervous "activity" (integrated nerve firing rate) for the body as a whole and for individual organs. In 12 patients with cardiac failure (left ventricular ejection fraction 10% to 39%), the mean arterial plasma norepinephrine concentration was 557 +/- 68 pg/ml (mean +/- SE) compared with 211 +/- 21 pg/ml in 15 subjects without heart failure (p less than .002). The difference was due to both increased release of norepinephrine to plasma (indicating increased "total" sympathetic activity) and reduced clearance of norepinephrine from plasma. The increase in sympathetic activity did not involve all organs equally. Cardiac (32 +/- 9 vs 5 +/- 1 ng/min; p less than .002) and renal (202 +/- 45 vs 66 +/- 9 ng/min; p = .002) norepinephrine spillover were increased by 540% and 206%, respectively, but norepinephrine spillover from the lungs was normal. Adrenomedullary activity was also increased in the patients with heart failure, whose mean arterial plasma epinephrine concentration was 181 +/- 38 pg/ml compared with 71 +/- 12 pg/ml in control subjects (p less than .02). There is marked regional variation, inapparent from measurements of plasma norepinephrine concentration, in sympathetic nerve activity in patients with congestive heart failure. The finding of increased cardiorenal norepinephrine spillover has important pathophysiologic and therapeutic implications.
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For cardiac sympathetic activation, the ranking is cardiac failure > normal-weight essential hypertension > depressive illness > aging.
“The ranking is as follows: for cardiac sympathetic activation, cardiac failure>normal-weight essential hypertension>depressive ill ness>aging.19,22,24,42,44,45,49,78”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [44]
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Self-citation
- Authors
- Hasking, G. J., Esler, M. D., Jennings, G. L., Burton, D., Johns, J. A., & Korner, P. I.
- Venue
- Circulation
- Published
- 1986-04
- Volume
- 73
- Issue
- 4
- Pages
- 615-621
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2071526303
- Cited by
- 1,028
- References
- 34
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 8 · 2023: 24 · 2022: 12 · 2021: 16 · 2020: 23 · 2019: 16 · 2018: 19 · 2017: 36 · 2016: 42 · 2015: 40 · 2014: 46 · 2013: 40 · 2012: 38
- FWCI
- 14.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- norepinephrine spillover, congestive heart failure, sympathetic activity, norepinephrine clearance, epinephrine
- MeSH terms
- Female, Heart Conduction System, Heart Failure, Hemodynamics, Humans, Kidney, Lung, Male, Middle Aged, Myocardium, Norepinephrine, Receptors, Adrenergic, Sympathetic Nervous System
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