Augmented Peripheral Chemosensitivity as a Potential Input to Baroreflex Impairment and Autonomic Imbalance in Chronic Heart Failure

DOI Web Site 被引用文献4件
  • Piotr Ponikowski
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Tuan Peng Chua
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Massimo Piepoli
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Daniela Ondusova
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Katharine Webb-Peploe
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Derek Harrington
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Stefan D. Anker
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Maurizio Volterrani
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Roberto Colombo
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Giorgio Mazzuero
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Amerigo Giordano
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.
  • Andrew J. S. Coats
    From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione “Salvatore Maugeri,” Italy.

説明

<jats:p> <jats:italic>Background</jats:italic> The precise mechanisms responsible for the sympathetic overactivity and blunted baroreflex control in chronic heart failure (CHF) remain obscure. Augmented peripheral chemosensitivity has recently been demonstrated in CHF. We evaluated the relation between peripheral chemoreflex sensitivity and autonomic activity in patients with CHF. </jats:p> <jats:p> <jats:italic>Methods and Results</jats:italic> We studied in 26 stable patients with CHF the peripheral chemosensitivity (ventilatory response to hypoxia using transient inhalations of pure nitrogen), autonomic balance (spectral analysis of heart rate variability [HRV]), and baroreflex sensitivity (bolus phenylephrine method and α index). To determine whether transient inactivation of peripheral chemoreceptors might influence autonomic balance, 12 patients underwent a second study during which they breathed 100% O <jats:sub>2</jats:sub> . Peripheral chemosensitivity correlated inversely with HRV power within the low-frequency band (0.04 to 0.15 Hz) ( <jats:italic>r</jats:italic> =−.52, <jats:italic>P</jats:italic> =.006) and inversely with baroreflex sensitivity ( <jats:italic>r</jats:italic> =−.60, <jats:italic>P</jats:italic> =.005). When the patients were divided into two groups according to the chemosensitivity of age-matched normal controls (above and below mean+2 SDs of chemosensitivity of control subjects), those above the normal range revealed more impaired autonomic balance, ie, lower baroreflex sensitivity (1.4±1.3 versus 5.0±1.5 ms/mm Hg, <jats:italic>P</jats:italic> <.0001) and depressed values of low-frequency power (2.5±1.8 versus 4.1±0.8 ln ms <jats:sup>2</jats:sup> , <jats:italic>P</jats:italic> <.005) compared with those with normal chemosensitivity. Transient hyperoxia did not alter heart rate or systolic pressure but resulted in an increase in HRV and an improvement in baroreflex sensitivity. </jats:p> <jats:p> <jats:italic>Conclusions</jats:italic> A link between increased peripheral chemosensitivity and impaired autonomic control, including baroreflex inhibition, is demonstrated. The clinical importance of this phenomenon warrants further investigation. </jats:p>

収録刊行物

  • Circulation

    Circulation 96 (8), 2586-2594, 1997-10-21

    Ovid Technologies (Wolters Kluwer Health)

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