Characterization of Cardiac Sympathetic Nervous System and Inflammatory Activation in HFpEF Patients

David M Kaye; Shane Nanayakkara; Bing Wang; Waled Shihata; Francine Z Marques; Murray Esler; Gavin Lambert; Justin Mariani

doi:10.1016/j.jacbts.2021.11.007

Characterization of Cardiac Sympathetic Nervous System and Inflammatory Activation in HFpEF Patients

JACC Basic Transl Sci. 2022 Feb 28;7(2):116-127. doi: 10.1016/j.jacbts.2021.11.007. eCollection 2022 Feb.

Authors

David M Kaye^{1

2

3}, Shane Nanayakkara^{1

2}, Bing Wang^{2

3}, Waled Shihata¹, Francine Z Marques⁴, Murray Esler⁵, Gavin Lambert⁶, Justin Mariani^{1

2

3}

Affiliations

¹ Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.
² Department of Cardiology, Alfred Hospital, Melbourne, Australia.
³ Department of Medicine, Monash University, Melbourne, Australia.
⁴ Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia.
⁵ Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
⁶ Iverson Health Innovation Research Institute and School of Health Science, Swinburne University of Technology, Melbourne, Australia.

Abstract

We have shown that systemic and cardiac sympathetic activation is present in heart failure with preserved ejection fraction (HFpEF) patients. Conversely, whereas systemic inflammatory activation was also detected in HFpEF, we did not detect local myocardial release of inflammatory cytokines. Activation of the sympathetic system correlated with both hemodynamic and demographic factors that characteristically cluster together in HFpEF. Together these data suggest that there may be a role for antiadrenergic therapies in certain HFpEF patients. The study does not implicate locally derived cytokines in the myocardial biology of HFpEF, although systemic sources may contribute to the global pathophysiology of HFpEF.

Keywords: BMI, body mass index; HFpEF, heart failure with preserved ejection fraction; NE, norepinephrine; PCWP, pulmonary capillary wedge pressure; SBP, systolic blood pressure; TCNE gradient, transcardiac NE gradient; cytokines; heart failure with preserved ejection fraction; sympathetic nervous system; transcardiac biomarker gradient.