Correlation Between Facial Temperature Difference And Sympathetic Nervous Activity And Remodeling In Patients With Heart Failure

Objective: The purpose of this study was to explore temperature distribution in the face of infrared images and its its correlation between sympathetic activity in patients with heart failure.Mothods: We applied a cross-sectional,observational study,consecutive patients in hospital were enrolled.An IRTI camera was used to obtain facial thermal images in all patients,and the level of serum norepinephrine were measured.All collected data were entered into database,the correlation between two dimensional information of face temperature and norepinephrine were analyzed.Results: A total of 104 patients were selected for the present study.The patients were divided into 4 groups,normal heart function group(control group,28 cases),heart failure with preserved ejection fraction(HFp EF,33 cases),heart failure with mid-range ejection fraction(HFmr EF,20 cases)and cases heart failure with reduced ejection fraction(HFr EF,23 cases).Among the groups,significantly different levels of norepinephrine were found(p<0.01).There were no statistically significant differences between the inner canthus temperature,reflecting the high temperature region,in each group(P>0.05),but the average temperature between HFmr EF group and HFr EF group decreased statistically significant(32.66 ± 1.61,32.94 ± 1.18 vs 33.75 ± 1.44,P<0.05).The cheek temperature,reflecting the low temperature region,decreased significantly in HFp EF,HFmr EF and HFr EF group(32.10 ± 2.03,30.69± 1.68,30.75 ± 1.45 vs 33.19 ± 1.62,p<0.01).The inner canthus and cheek temperature difference increases obviously in HFmr EF and HFr EF group(3.99 ± 1.06,3.67 ± 1.58 vs 1.79 ± 1.19,p<0.01),the level was positive correlated with the level of norepinephrine(r=0.401,P<0.01).Conclusion: Our research found that sympathetic activation leads to a decrease in skin blood flow,resulting in a decrease in skin temperature in heart failure.Temperature profile of the infrared image were different in heart failure compared with normal cardiac function,which might be correlated with sympathetic activity.Objective: In this part,we aimed evaluate clinical value of dimensional information in facial temperature by infrared thermal imaging for diagnostic heart failure and sympathetic activation.Methods: Firstly,the correlation between facial temperature distribution and axillary temperature,ambient temperature and cardiac function were analyzed.Secondly,we used multiple regression to explore current clinical factors affecting sympathetic activation and inner canthus-cheek temperature difference.Finally,the diagnostic test model were constructed.We defined cut-off point of left ventricular ejection fraction(LVEF)in 50% and norepinephrine(NE)in 1000pg/ml as the reduction in cardiac output and sympathetic overactivation.Making receiver operating characteristic curve(ROC)to find the the cut-off point of temperature difference and explore diagnostic value of each intersection point analysis by the youden index.Results: 1.There were closely related with the maximum temperature in face and axillary temperature(r=0.739,p<0.01),and no correlation between ambient temperature.2.Multiple regression analysis showed that main factors affecting sympathetic activation were LVEF(?=-0.37,P = 0.014)and ambient temperature(?=-0.332,P=0.004),factors of inner canthus-cheek temperature difference were LVEF(? =-0.311,P = 0.014),age(?= 0.235,P = 0.039)and the ambient temperature(?= 0.083,P = 0.036).LVEF 50% was used as the cut-off point for reduced LVEF,AUC of inner canthus-cheek temperature curve was 0.769(p<0.01).NE > 1000pg/ml was cut-off point for sympathetic overactivation,AUC was 0.645(p<0.05).Conclusion: Face temperature might be a method for monitoring body temperature.Although sympathetic activation and temperature difference could be affected by the ambient temperature,the inner canthus-cheek temperature difference has certain significance for screening of heart failure with reduced LVEF and sympathetic activation when the environment was relatively constant.Infrared thermal imaging might be used as an auxiliary methods.Objective: Sympathetic activation and remodeling is characteristic of heart failure,which may influence the temperature regulation.The aim of this part is to research the correlation between renalase,angiotensin II sympathetic nerve remodeling index(growth associated protein 43,GAP 43 and nerve growth factor,NGF)and temperature difference.Methods: From patients of the first part,we used enzyme linked immunosorbent assay for detection of serum renalase,GAP43,NGF and angiotensin II.We analysis the differences between each group and explore the correlation among the indexes.Results: 1.Compared with normal heart function group,renalase(5.0±1.6,5.7±2.1 vs 7.2±1.9,p<0.05),GAP43(7.0±2.2,6.9±2.9 vs 9.9±2.1,p<0.05)and NGF(252±84,248±78 vs 350±127,p<0.05)in heart failure patients was significantly decreased,and the level of angiotensin II increased(270.43±95.6,282.12±74.3 vs 179.43±82.8,p<0.05).2.The norepinephrine levels were negatively correlated with renalase(r=-0.462),GAP43(r=-0.848)and NGF(r=-0.81)(p<0.01)and positive correlation between angiotensin II(r=0.373,p=0.02).3.LVEF were positive correlation with GAP43(r=0.312,p=0.01),NGF(r=0.389,p=0.001),and negatively correlated with AT II(r=-0.394,p<0.01).4.The temperature difference also showed a negative correlation with GAP43(r=-0.308,p=0.011)and NGF(r=-0.277,p=0.023),but positive correlation with AT II(r=0.732,p<0.001).Conclusion: Decreased of renalase and inceased angiotensin II may lead to over activation and remodeling of sympathetic nerve,which results in cardiac function impaired and might be one of the reasons for the decrease of body temperature regulation in patients with heart failure.Objective: To investigate the effect of Omega-3 on sympathetic activity and cardiac function in patients with heart failure by meta-analysis.Methods: For this study,we compiled articles obtained from Pub Med,EMBSAE and the Cochrane Library.We selected publications that included RCTs to investigate the effect of additional omega-3 PUFAs on brain natriuretic peptide(BNP)or N-terminal pro B-type natriuretic peptide(NT-pro BNP),left ventricular ejection fraction(LVEF)and serum norepinephrine(SNE)levels.Two reviewers independently extracted data from the selected publications.We calculated the pooled weighted mean difference(WMD)or standardized mean difference(SMD)with associated 95% confidence interval(CI).Quality assessment,subgroup,sensitivity and publication bias analyses were performed.Results: Nine RCTs involving a total of 800 patients were eligible for inclusion.Compared to patients taking placebos,HF patients that received omega-3 PUFAs experienced significantly decreased SNE levels(WMD =-186.35,95% CI =-347.22 to-25.49;P = 0.258,I2 = 26.2%)and BNP levels(WMD =-138.50,95% CI =-203.65 to-73.35;P =0.257,I2 =26.4%).Subgroup analysis showed that LVEF levels were significantly increased in dilated cardiomyopathy(DCM)patients(WMD = 3.48,95% CI = 1.71 to 5.24;P = 0.525,I2 = 0.0%).Conclusion: Omega-3 PUFAs supplements might be beneficial to CHF patients,but further studies are needed to confirm these benefits.