The Role of Catecholamines in Circulatory Regulation on the Chronic Congestive Heart Failure : Clinical Study of the Urinary Catecholamine Excretion in the Patients with Chronic Congestive Heart Failure

In order to determine the excretion pattern of urinary catecholamines and ensure the role of the catecholamines in the chronic congestive heart failure, 24-hour urinary catecholamines were determined by THI-method on 100 patients with chronic congestive heart failure caused by various underlying diseases. 1) The level of urinary catecholamines, especially that of norepinephrine, in both hydrolyzed and non-hydrolyzed form, were found to be increased progressively corresponding to the aggravation of severity of heart failure. This result suggests the extreme acceleration of sympathetic nervous system in congestive heart failure. 2) The observation that the elevation of venous pressure corresponded to an increase in urinary norepinephrine may be a reflection of the presence of neurohumoral regulation of venous pressure. 3) Correlation between the urinary norepinephrine value and decrease rate of vital capacity were observed. 4) There was fairly close correlation between the urinary norepinephrine value and renal plasma flow. This result suggests the contribution of sympatho-adrenal stimulation to the reduced renal hemodynamics in the heart failure. Fifteen patients were laid on time-course study. 5) The urinary norepinephrine level decreased gradually corresponding to the decrease in severity of heart failure. 6) The temporary rise in the urinary norepinephrine level was generally observed in the initial phase of digitalisation. It may be reasonable to assume that the augmented sympathetic nervous system may play a certain role, preferably supportive, to gain the effect of digitalis glycoside on the failing myocardium. 7) Five cases, including 3 with refractory heart failure, were treated with diuretics in addition to the digitalisation. The results obtained may indicate that the "enforced diuresis" by the diuretics, unlike "natural" or "physiologic diuresis" by digitalisation, may produce the augmented sympathetic nervous system until the occurrence of adaptation response to the conditions brought about by the "enforced diuresis" and that repeated performance of the "enforced diuresis" finally led the heart failure to refractory, and the patient to death when the reinforcement of the augmented sympathetic nervous system is deprived by its exhaustion. 8) Moreover, the indication that intensification of the heart failure was observed in the 2 cases laid on the administration of antiadrenergic drugs, may imply the adrenergic support to myocardial function regulating the heart failure. In conclusion, these results may be interpreted to mean with certainty that the sympathetic nervous system plays an important compensatory role in the circulatory regulation of patient to congestive heart failure.