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Catecholamine excretion and cardiac stores of norepinephrine in congestive heart failure

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      Abstract

      The role of the sympathetic nervous system in congestive heart failure was studied by determining the urinary excretion of norepinephrine and its concentration in cardiac tissue. Norepinephrine excretion averaged 22.5 μg. per day in normal subjects and 22.4 μg. per day in class I or II cardiac patients. It was increased in patients with heart failure, averaging 46.4 μg. per day in class III patients and 58.1 μg. per day in class IV patients. No significant increase in urinary excretion of epinephrine or vanilmandelic acid was observed in the patients with heart failure. The norepinephrine excretion was substantially increased in all patients by the stress of a corrective cardiac operation.
      The concentration of norepinephrine in atrial tissue was found to be reduced in patients with heart failure, averaging 0.49 μg. per gm. compared to 1.77 μg. per gm. in cardiac patients without failure. A reduction of norepinephrine was also observed in the left ventricle, and the concentrations in the ventricle were found to be lowest in the patients with the lowest atrial norepinephrine concentrations. Increased urinary excretion of norepinephrine was observed in patients with markedly depressed cardiac concentrations of the neurotransmitter substance.
      It is concluded that heart failure is associated with augmented activity of the sympathetic nervous system, reflected in increased norepinephrine excretion and often associated with a deficit of cardiac norepinephrine. It is suggested that in patients in whom depletion of neurotransmitter in the heart is most pronounced, there may be a relative deficiency of sympathetic function which in turn adversely affects the contractile state of the myocardium.
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