TY - JOUR
T1 - Peripheral chemoreceptor hypersensitivity an ominous sign in patients with chronic heart failure
AU - Ponikowski, Piotr
AU - Chua, Tuan Peng
AU - Anker, Stefan D.
AU - Francis, Darrel P.
AU - Doehner, Wolfram
AU - Banasiak, Waldemar
AU - Poole-Wilson, Phillip A.
AU - Piepoli, Massimo F.
AU - Coats, Andrew J S
PY - 2001/7/31
Y1 - 2001/7/31
N2 - Background - Peripheral chemoreceptor hypersensitivity is a feature of abnormal cardiorespiratory reflex control in chronic heart failure (CHF) and may contribute to sympathetic overactivity, attenuated baroreflex sensitivity (BRS), and excessive ventilation during exercise. We studied whether augmented peripheral chemosensitivity carries independent prognostic significance. Methods and Results - We assessed peripheral chemosensitivity (ventilatory response to hypoxia using transient inhalation of pure nitrogen) and BRS (phenylephrine and spectral methods) in 80 consecutive CHF patients (age 58±9 years; left ventricular ejection fraction [LVEF] 24±12%; peak oxygen consumption [peak V̇O2] 18±7 mL-1·min-1). CHF patients demonstrated augmented peripheral chemosensitivity and decreased BRS (all P3 years in all survivors), 37 patients died. High peripheral chemosensitivity (>0.72 L · min-1 · %Sao2-1) predicted impaired survival (hazard ratio 3.2, 95% CI 1.6 to 6.0, P=0.0006). In the 27 patients (34%) with high peripheral chemosensitivity, 3-year survival was 41% (95% CI 22% to 60%) compared with 77% (66% to 89%) in 53 patients with normal chemosensitivity (P=0.0002). In multivariate analyses, augmented chemosensitivity independently predicted death (hazard ratio 2.8, 95% CI 1.5 to 5.5, adjusted for age, peak V̇O2, and V̇E/V̇CO2 [P= 0.002]; hazard ratio 2.6, 95% CI 1.3 to 5.1, adjusted for age, LVEF, and peak V̇O2 [P=0.008]). Depressed BRS was related to unfavorable prognosis in univariate analysis (P=0.05) but not in multivariate analyses. Conclusions - Hypersensitivity of the peripheral chemoreceptors independently predicts adverse prognosis in ambulatory patients with CHF. This hyperactive excitatory reflex, through its inhibitory effect on the baroreflex, may be the reason for the previously observed prognostic association of the latter.
AB - Background - Peripheral chemoreceptor hypersensitivity is a feature of abnormal cardiorespiratory reflex control in chronic heart failure (CHF) and may contribute to sympathetic overactivity, attenuated baroreflex sensitivity (BRS), and excessive ventilation during exercise. We studied whether augmented peripheral chemosensitivity carries independent prognostic significance. Methods and Results - We assessed peripheral chemosensitivity (ventilatory response to hypoxia using transient inhalation of pure nitrogen) and BRS (phenylephrine and spectral methods) in 80 consecutive CHF patients (age 58±9 years; left ventricular ejection fraction [LVEF] 24±12%; peak oxygen consumption [peak V̇O2] 18±7 mL-1·min-1). CHF patients demonstrated augmented peripheral chemosensitivity and decreased BRS (all P3 years in all survivors), 37 patients died. High peripheral chemosensitivity (>0.72 L · min-1 · %Sao2-1) predicted impaired survival (hazard ratio 3.2, 95% CI 1.6 to 6.0, P=0.0006). In the 27 patients (34%) with high peripheral chemosensitivity, 3-year survival was 41% (95% CI 22% to 60%) compared with 77% (66% to 89%) in 53 patients with normal chemosensitivity (P=0.0002). In multivariate analyses, augmented chemosensitivity independently predicted death (hazard ratio 2.8, 95% CI 1.5 to 5.5, adjusted for age, peak V̇O2, and V̇E/V̇CO2 [P= 0.002]; hazard ratio 2.6, 95% CI 1.3 to 5.1, adjusted for age, LVEF, and peak V̇O2 [P=0.008]). Depressed BRS was related to unfavorable prognosis in univariate analysis (P=0.05) but not in multivariate analyses. Conclusions - Hypersensitivity of the peripheral chemoreceptors independently predicts adverse prognosis in ambulatory patients with CHF. This hyperactive excitatory reflex, through its inhibitory effect on the baroreflex, may be the reason for the previously observed prognostic association of the latter.
KW - Baroreceptors
KW - Heart failure
KW - Peripheral chemoreceptors
KW - Prognosis
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M3 - Article
C2 - 11479251
AN - SCOPUS:0035979393
VL - 104
SP - 544
EP - 549
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 5
ER -