Characteristics of neuro-humoral activation in aged heart failure

Abstract

Background: Impaired reserve for adaptation to altered neuro-humoral condition is the major cause for aggravation of heart failure in aged patients. However, it is uncertain whether beta-blockade is readily applicable for aged heart failure patients. Methods: The hospitalized 64 patients with heart failure were enrolled. Alterations of neuro-humoral factors before and after treatment, heart rate variability (HRV) on Holter ECG and MIBG scintigraphic findings were compared between the aged (>70) and non-aged (<70) groups. Results: NYHA class was greater in aged (2.9 ± 0.2) compared to non-aged (2.6 ± 0.2) groups. Although the parameters of echocardiography on admission were not significantly different between two groups, the recovery of them was retarded in aged group. Plasma ANP and BNP, particularly ANP levels were significantly higher in aged (179.7 ± 36.9) than non aged group (97.7 ± 11.4 pg/ml). The variability of average heart rate tended to be diminished in aged group, and the average heart rate during the night was significantly higher in aged (65.4 ± 2.5) than non-aged group (59.5 ± 2.7/min). LF/HF of HRV was significantly greater in aged (1.2 ± 0.1) compared to non-aged group (1.6 ± 0.1). H/M and washout rate in MIBG tended to be greater in aged group. Conclusion: Neuro-humoral activation, particularly in sympathetic nervous system was a common feature even in aged patients. Sluggish process of adaptation must be considered in application of beta-blockade therapy in aged heart failure patients.