Relationships among norepinephrine levels, exercise capacity, and chronotropic responses in heart failure patients

In heart failure (HF) patients, the pathophysiological mechanisms of severe exercise intolerance and impaired exercise capacity are related to both central and peripheral abnormalities. The central abnormalities in HF patients include impaired cardiac function and chronotropic incompetence (CI). Ind...

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Published in:Heart failure reviews 2023-01, Vol.28 (1), p.35-45
Main Authors: Grosman-Rimon, Liza, Wright, Evan, Sabovich, Solomon, Rimon, Jordan, Gleitman, Sagi, Sudarsky, Doron, Lubovich, Alla, Gabizon, Itzhak, Lalonde, Spencer D., Tsuk, Sharon, McDonald, Michael A., Rao, Vivek, Gutterman, David, Jorde, Ulrich P., Carasso, Shemy, Kachel, Erez
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists
Adrenergic receptors
Cardiology
Catecholamines
Congestive heart failure
Ejection fraction
Exercise
Exercise - physiology
Exercise Test
Exercise Tolerance
Heart Failure
Heart rate
Heart Rate - physiology
Humans
Intolerance
Medical prognosis
Medicine
Medicine & Public Health
Nervous system
Norepinephrine
Physical activity
Physical fitness
Physical training
Sympathetic nervous system
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Summary:In heart failure (HF) patients, the pathophysiological mechanisms of severe exercise intolerance and impaired exercise capacity are related to both central and peripheral abnormalities. The central abnormalities in HF patients include impaired cardiac function and chronotropic incompetence (CI). Indeed, CI, the inability to adequately increase heart rate (HR) from rest to exercise often exhibited by HF patients, is related to activation of the sympathetic nervous system (SNS) yielding a rise in circulating norepinephrine (NE). CI may result from downregulation of β-adrenergic receptors, β-blocker usage, high baseline HR, or due to a combination of factors. This paper discusses the role of elevated NE in altering chronotropic responses in HF patients and consequently resulting in impaired exercise capacity. We suggest that future research should focus on the potential treatment of CI with rate-adaptive pacing, using a sensor to measure physical activity, without inducing deleterious hormonal activation of the sympathetic system.
ISSN:1573-7322
1382-4147
1573-7322
DOI:10.1007/s10741-022-10232-y