Regional heterogeneity of myocardial norepinephrine and lipid peroxidation levels in patients with end-stage heart failure

Abstract : Objectives-Regional alterations in norepinephrine (NE) and lipid peroxidation in the myocardium of patients with heart failure is not well known; this study was designed to investigate regional myocardial NE levels and the lipid peroxidation index and their relationship with the functional parameters in two pathologies (dilated and ischemic cardiomyopathies: DCM and ICM). Methods and Results-Biopsied heart samples were obtained from 13 DCM and 10 ICM patients (orthotopic cardiac transplantation). Non-failing hearts (n=4) were included in this study (controls: C). Left ventricular dysfunction was present at rest with a mean of LVEF of 19.1 ± 2.6 % (DCM) and 17.4 ± 2.0 % (ICM). The amounts of NE in the control hearts (4 patients) were significantly lower (p<0.05) than those in patients with DCM or ICM. In all patients, there were several differences in the distribution of NE among the subdivisions of the atria and ventricles studied. The NE content was significantly higher in the right atria than in the left atria or in ventricles. A significant correlation between LVEF and NE concentrations was observed in the left septum of ICM and DCM patients and in the left ventricles of the ICM group. In DCM and ICM patients, some parts of the left ventricle showed high levels of lipid peroxides. Conclusions-It is the first demonstration of a correlation between values of the preoperative LVEF and cardiac NE concentrations in some specific parts of the myocardium; this effect is not generalized to the whole heart.