[Inhibition of the neurohumoral axis after intravascular fluid depletion in congestive heart failure with water retention: mechanisms of the perpetuation of the syndrome]. / Inibizione dell'asse neuroumorale dopo deplezione di fluido intravascolare nello scompenso cardiaco congestizio con ritenzione idrica: meccanismi di perpetuazione della sindrome.

ABSTRACT

Hypovolemia stimulates the sympathoadrenal and renin systems and water retention. In congestive heart failure (CHF) reduced cardiac output and blood pressure have been suggested to be perceived as a volume deficit, which, if persistent, would perpetuate humoral activation and fluid retention. In the aim of probing this hypothesis, we monitored in patients with CHF the neurohumoral response to reduction of the body fluid obtained by ultrafiltration. In 22 patients with advanced CHF and fluid retention, ultrafiltration was performed with a diafilter, which was part of an external venous circuit, whose flow was regulated to produce 500 ml/hour of ultrafiltrate (average total amount 3,122 +/- 1,199 ml) until right atrial pressure was reduced to 50% of baseline. Hemodynamics, plasma renin activity, norepinephrine and aldosterone were measured before and in the 48 hours after ultrafiltration. Soon after the procedure, associated with a 20% reduction of plasma volume and a moderate decrease of cardiac output and blood pressure (consistent with a diminished degree of filling of the arterial compartment), there was an obvious fall of norepinephrine, plasma renin activity and aldosterone. In the next 48 hours we recorded an increasing neurohumoral axis depression, in spite of recovery of plasma volume, cardiac output and blood pressure and a striking enhancement in urinary output. Changes in norepinephrine, plasma renin activity or aldosterone were not related to the combination of changes in plasma volume, cardiac output and blood pressure (variations in the state of arterial filling) and significantly correlated with the increase in urinary output and sodium excretion.(ABSTRACT TRUNCATED AT 250 WORDS)