948-46 Preserved Cardiac Baroreflex Control of Renal Cortical Blood Flow in Advanced Heart Failure Patients: A Positron Emission Tomography Study

Cardiac baroreflex (CBR) control of forearm blood flow (FBF) is blunted or reversed in humans with heart failure (HF). but little is known about CBR control of renal cortical blood flow (RCBF) in HF due to technical limitations. Positron emission tomography (PET) 0–15 water is a new, precise method to measure RCBF quantitatively. We compared CBR control of RCBF and FBF (venous plethysmography) in 8 patients with HF (mean age, 47±3 y, ejection fraction 0.25±0.02) and 10 normal humans (mean age 35±5 y) during CBR unloading with phlebotomy (450ml). In 5 normals, cold pressor test was used as a strong, non-baroreflex mediated stimulus to vasoconstriction.ResultsPhlebotomy decreased central venous pressure (p <0.001), but did not change mean arterial pressure or heart rate in HF patients or controls. The major findings of the study are: 1) At rest, RCBF is markedly diminished in HF vs normals (2.4±0.1 vs 4.3±0.2ml/min/g, p < 0.001). 2) In normal humans during phlebotomy, FBF decreased substantially (basal vs phlebotomy: 3.3±0.4 vs 2.6±0.3 ml/min/100 ml, p=0.021, and RCBF decreased slightly, but significantly (basal vs phlebotomy: 4.3±0.2 vs 4.0±0.3 ml/min/g, p=0.01). 3) The small magnitude of reflex renal vasoconstriction is not explained by the inability of the renal circulation to vasoconstrict since the cold pressor stimulus induced substantial decreases in RCBF in normals (basal vs cold pressor: 4.4±0.1 vs 3.7±0.1 ml/min/g, p=0.003). 4) In humans with heart failure during phlebotomy, FBF did not change (basal vs phlebotomy: 2.6±0.3 vs 2.7±0.2 ml/min/100 ml, p=NS), but RCBF decreased slightly but significantly (basal vs phlebotomy: 2.4±0.1 vs 2.1±0.1 ml/min/g, p=0.01). Thus, in patients with heart failure, there is an abnormality in cardiopulmonary baroreflex control of the forearm circulation, but not the renal circulationConclusionThis study 1) shows the power of PET to study physiologic and pathophysiologic reflex control of the renal circulation in humans, and 2) describes the novel finding of selective dysfunction of cardiac baroreflex control of the forearm circulation, but its preservation of the renal circulation, in patients with heart failur