Sympathetic dysfunction is associated with worse fatigue and early and subtle symptoms in heart failure: an exploratory sex-stratified analysis

Nina Stutsman; Beth Habecker; Noelle Pavlovic; Corrine Y Jurgens; William R Woodward; Christopher S Lee; Quin E Denfeld

doi:10.1093/eurjcn/zvad121

Sympathetic dysfunction is associated with worse fatigue and early and subtle symptoms in heart failure: an exploratory sex-stratified analysis

Eur J Cardiovasc Nurs. 2024 Jan 10:zvad121. doi: 10.1093/eurjcn/zvad121. Online ahead of print.

Authors

Nina Stutsman¹, Beth Habecker^{2

3}, Noelle Pavlovic⁴, Corrine Y Jurgens⁵, William R Woodward³, Christopher S Lee^{5

6}, Quin E Denfeld^{1

2}

Affiliations

¹ Oregon Health & Science University, School of Nursing, 3455 SW U.S. Veteran's Hospital Road, Portland, OR 97239, USA.
² Oregon Health & Science University, Knight Cardiovascular Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
³ Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
⁴ Johns Hopkins School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.
⁵ Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
⁶ Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC 3065, Australia.

PMID: 38196102
DOI: 10.1093/eurjcn/zvad121

Abstract

Aims: Physical symptoms impact patients with heart failure (HF) despite treatment advancements; however, our understanding of the pathogenic mechanisms underlying HF symptoms remains limited, including sex differences therein. The objective of this study was to quantify associations between sympathetic markers [norepinephrine (NE) and 3,4-dihydroxyphenylglycol (DHPG)] and physical symptoms in patients with HF and to explore sex differences in these associations.

Methods and results: We performed a secondary analysis of combined data from two studies: outpatients with HF (n = 111), and patients prior to left ventricular assist device implantation (n = 38). Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) dyspnoea and early/subtle symptom subscales and the Functional Assessment in Chronic Illness Therapy Fatigue Scale (FACIT-F) to capture dyspnoea, early symptoms of decompensation, and fatigue. Norepinephrine and DHPG were measured with high-performance liquid chromatography with electrochemical detection. Multivariate linear regression was used to quantify associations between symptoms and sympathetic markers. The sample (n = 149) was 60.8 ± 15.7 years, 41% women, and 71% non-ischaemic aetiology. Increased plasma NE and NE:DHPG ratio were associated with worse FACIT-F scores (P = 0.043 and P = 0.013, respectively). Increased plasma NE:DHPG ratio was associated with worse HFSPS early/subtle symptoms (P = 0.025). In sex-stratified analyses, increased NE:DHPG ratio was associated with worse FACIT-F scores (P = 0.011) and HFSPS early/subtle scores (P = 0.022) among women but not men.

Conclusion: In patients with HF, sympathetic dysfunction is associated with worse fatigue and early/subtle physical symptoms with associations stronger in women than men.

Keywords: Biomarkers; Heart failure; Sex differences; Sympathetic nervous system; Symptoms.

Abstract

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