Clinical investigations: Congestive heart failureRole of central sympathoexcitation in enhanced hypercapnic chemosensitivity in patients with heart failure☆
Section snippets
Study patients
Ninety-nine patients with stable chronic heart failure (77 men, 22 women) were studied (Table I). The causes of cardiac disease were dilated cardiomyopathy in 51 patients, prior myocardial infarction in 12, valvular heart disease in 15, and miscellaneous causes in 21. Functional status was New York Heart Association (NYHA) functional class I in 47 patients, class II in 18, and class III in 34. Specific activity scales7 obtained from interviewing daily physical activities were 5.6 ± 1.8
Hypercapnic chemosensitivity and functional impairment
The relationship between hypercapnic chemosensitivity and ventilatory, cardiac, and neurohumoral variables is summarized in Table II.Although hypercapnic chemosensitivity did not correlate with exercise capacity assessed by peak Vo2 and the anaerobic threshold, there was a significant inverse correlation between chemosensitivity and ordinary physical activity assessed by the specific activity scale. A close positive correlation was found between chemosensitivity and exercise ventilatory
Discussion
The present study revealed the causative relationship between sympathetic nerve activity and enhanced hypercapnic chemosensitivity in patients with chronic heart failure. Another important finding of this study is that the effect of the sympatholytic agent on hypercapnic chemosensitivity depends on the baseline chemosensitivity. Patients with a higher hypercapnic chemosensitivity benefited more from the central sympatholytic agent guanfacine. Similarly, central sympathoinhibition resulted in a
References (33)
- et al.
Importance of abnormal lung perfusion in excessive exercise ventilation in chronic heart failure
Am Heart J
(1993) - et al.
Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure
J Am Coll Cardiol
(1996) - et al.
Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure
J Am Coll Cardiol
(1997) - et al.
Experimentally induced Cheyne-Stokes breathing
Respir Physiol
(1979) - et al.
Pathophysiologic and therapeutic implications of sleep apnea in congestive heart failure
J Card Fail
(1996) Heart failure 99—the MOXCON trial
Int J Cardiol
(1999)- et al.
Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities
Circulation
(1988) - et al.
Enhanced sympathetic and ventilatory responses to central chemoreflex activation in heart failure
Circulation
(1999) - et al.
Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure
Circulation
(1997) - et al.
Evaluation of functional capacity of patients with congestive heart failure
A clinical method for assessing the ventilatory response to carbon dioxide
Australas Ann Med
Relationship between low-frequency cardiovascular variability and muscle sympathetic nerve activity in patients with cardiac dysfunction
J Cardiovasc Pharmacol
Changes in autonomic regulation induced by physical training in mild hypertension
Hypertension
Central and peripheral chemoreflex loop gain in normal and carotid body-resected subjects
J Appl Physiol
Respiratory dysrhythmias during sleep
N Engl J Med
Augmentation of chemosensitivity during mild exercise in normal human
J Appl Physiol
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2022, Biomedicine and PharmacotherapyCentral Chemoreceptor Sensitivity Is Not Enhanced in Contemporary Patients With Chronic Systolic Heart Failure Receiving Optimal Treatment
2017, Journal of Cardiac FailureCitation Excerpt :The central sympatho-inhibition with guanfacine decreased CChS in CHF patients,8 and CHF patients displayed lower CChS once treated with carvedilol vs bisoprolol.24 Beta-blockers may also influence CChS indirectly through hemodynamic actions.8,23 The other drugs, especially angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, are believed to influence the cardiorespiratory reflexes; however, Solaiman et al.25 demonstrated in healthy adults that acutely increasing plasma angiotensin-II does not alter CChS.
Parasympathetic activation by pyridostigmine on chemoreflex sensitivity in heart-failure rats
2013, Autonomic Neuroscience: Basic and ClinicalCitation Excerpt :In addition, Ponikowski et al. (2001) have shown that augmented peripheral chemoreflex sensitivity is an independent predictor of mortality in HF patients. Likewise, previous studies have shown enhanced central chemoreflex sensitivity in HF patients (Narkiewicz et al., 1999; Ueno et al., 2004; Yamada et al., 2004). However, experimental studies have demonstrated that HF does not alter the central chemoreflex sensitivity of rabbits (Sun et al., 1999) and anesthetized rats (Kristen et al., 2002).
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Supported by Grant-in-Aid for General Scientific Research No 13670697 from the Ministry of Education, Science and Culture of Japan.