Open AccessAberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure
Author(s) -
Woo Mary A.,
Macey Paul M.,
Keens Peter T.,
Kumar Rajesh,
Fonarow Gregg C.,
Hamilton Michele A.,
Harper Ronald M.
Publication year - 2007
Publication title -
congestive heart failure
Language(s) - English
Resource type - Journals
eISSN - 1751-7133
pISSN - 1527-5299
DOI - 10.1111/j.1527-5299.2007.05856.x
Subject(s) - medicine , valsalva maneuver , insula , putamen , cardiology , functional magnetic resonance imaging , heart failure , central nervous system , amygdala , neuroscience , ejection fraction , autonomic nervous system , magnetic resonance imaging , heart rate , blood pressure , psychology , radiology
Heart failure (HF) is associated with aberrant autonomic nervous system (ANS) activity, with altered responses to blood pressure and breathing challenges that appear to reflect abnormal central nervous system function. The authors used functional magnetic resonance imaging (fMRI) to determine whether the Valsalva maneuver, an ANS challenge, would show abnormal responses in ANS regulatory areas of the brain in HF. Brain fMRI signal changes in 5 HF patients (left ventricular ejection fraction, 0.15±0.08; age, 50±10 years) and 14 controls (age, 47±11 years) were assessed during 3 successive Valsalva maneuvers. The hypothalamus, hippocampus, putamen, amygdala, mid‐cingulate, right insula, and cerebellar cortex showed exaggerated and phase‐shifted fMRI responses in HF; other areas showed inverted signals from those found in controls. Central ANS control areas have altered phase, extent, and direction of responses to Valsalva maneuvers in a small sample of HF patients. These findings suggest that therapeutics that address neuroprotective aspects may be useful interventions for the condition.