Author + information
- Received January 18, 2013
- Revision received June 14, 2013
- Accepted June 20, 2013
- Published online November 1, 2013.
- Nicolas Dumonteil, MD∗,
- Angelica Vaccaro, MD†,‡,
- Fabien Despas, PharmaD, PhD†,‡,§,
- Marc Labrunee, MD∗,†,‡,
- Bertrand Marcheix, MD, PhD∗,†,‡,
- Elisabeth Lambert, PhD‖,
- Murray Esler, MD, PhD‖,
- Didier Carrie, MD, PhD∗,†,‡,
- Jean-Michel Senard, MD, PhD†,‡,§,
- Michel Galinier, MD, PhD∗,‡ and
- Atul Pathak, MD, PhD∗,†,‡,‖∗ ()
- ∗Service de Cardiologie, Pôle Cardiovasculaire et Métabolique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- †Institut National de la Sante et de la Recherche Médicale, UMR-1048, Institut des maladies métaboliques et cardiovasculaires, Toulouse, France
- ‡Université de Toulouse, UPS, Institut de Médecine Moléculaire de Rangueil, IFR31, Toulouse, France
- §Service de Pharmacologie médicale et clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- ‖Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- ↵∗Reprint requests and correspondence:
Dr. Atul Pathak, Service de Pharmacologie médicale et clinique, Faculté de Médecine, 37 Allées Jules Guesde, 31000 Toulouse, France.
Objectives This study sought to measure muscle sympathetic nerve activity (MSNA) in patients with aortic stenosis (AS) before and after transcatheter aortic valve implantation (TAVI) and to compare MSNA with that of control patients.
Background TAVI is an emerging therapeutic option in patients with severe AS at high risk of open heart surgery. Whether patients with AS have increased sympathetic activity remains to be established, and the effects of TAVI on the sympathetic nervous system are also unknown.
Methods We prospectively enrolled 14 patients with severe symptomatic AS treated by TAVI. Fourteen control patients matched for age, body mass index, and unscathed of AS were also included. All patients underwent MSNA and arterial baroreflex gain assessment at baseline and 1 week after TAVI for AS patients.
Results Patients with AS had lower blood pressure (BP) levels, a significant increase in MSNA (61.0 ± 1.7 burst/min vs. 55.4 ± 1.4 burst/min; p < 0.05), and a decrease in arterial baroreflex gain (2.13 ± 0.14% burst/mm Hg vs. 3.32 ± 0.19% burst/mm Hg; p < 0.01) compared with matched control patients. The TAVI procedures induced an increase in BP associated with a significant decrease in MSNA (from 61.0 ± 1.7 burst/min to 54.1 ± 1.0 burst/min; p < 0.01) and was associated with a significant increase in arterial baroreflex gain (from 2.13 ± 0.14% burst/mm Hg to 3.49 ± 0.33% burst/mm Hg; p < 0.01).
Conclusions We report for the first time, through direct measurement of nerve activity, that patients with AS have increased sympathetic nervous system activity associated with a decrease in sympathetic baroreflex gain and that TAVI normalizes these parameters. This study provides evidence of a new beneficial effect of TAVI, namely, normalization of sympathetic nervous system hyperactivity.
Dr. Dumonteil is a physician proctor for Edwards Lifescience, Medtronic, and Boston Scientific; and is a consultant for Biotronik. Dr. Marcheix is a physician proctor for Edwards Lifescience and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Dumonteil and Vaccaro contributed equally to this work.
- Received January 18, 2013.
- Revision received June 14, 2013.
- Accepted June 20, 2013.
- American College of Cardiology Foundation