NEUROHORMONAL ACTIVATION AND EXERCISE FUNCTION IN PATIENTS WITH SEVERE HEART-FAILURE AND PATIENTS WITH LEFT-VENTRICULAR ASSIST SYSTEM - A COMPARATIVE-STUDY

Objectives: The aim of this study was to evaluate the effects of impla ntation of a left ventricular assist system (LVAS) on the neurohormona l status, exercise capacity and symptomatic state in patients with sev ere congestive heart failure (CRF). Background: Severe CHF is characte rized by decreased exercise tolerance and activation of several neuroh ormonal systems. Methods: Parameters of neurohormonal activation and e xercise capacity in patients with LVAS (n=7) were compared with those in groups of New York Heart Association (NYHA) class 3 (n=121) and cla ss 4 (n=81) patients. Plasma levels of norepinephrine (NE), plasma ren in activity (PRA), and atrial natriuretic peptide (ANP) and maximal an d submaximal exercise capacities were measured monthly in LVAS patient s and compared with results in CHF patients. Results: Plasma NE and PR A levels were significantly lower in LVAS patients than in NYHA class 4 patients, and plasma ANP levels in LVAS patients were significantly lower than those in NYHA class 3 and 4 patients. The distance walked d uring submaximal exercise testing and peak oxygen consumption during m aximal exercise testing were similar for the LVAS and NYHA class 3 pat ients. The class 4 patients were unable to exercise. Conclusions: We c onclude that the LVAS lessens the neurohormonal activation and exercis e intolerance characteristic of the CHF state and that the exercise ca pacity early after LVAS (<4 months) is similar to that observed in NYH A class 3 patients.