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Titolo:
Peripheral chemoreceptor hypersensitivity - An ominous sign in patients with chronic heart failure
Autore:
Ponikowski, P; Chua, TP; Anker, SD; Francis, DP; Doehner, W; Banasiak, W; Poole-Wilson, PA; Piepoli, MF; Coats, AJS;
Indirizzi:
Natl Heart & Lung Inst, Clin Cardiol, London SW3 6LY, England Natl Heart &Lung Inst London England SW3 6LY l, London SW3 6LY, England Clin Mil Hosp, Dept Cardiol, Wroclaw, Poland Clin Mil Hosp Wroclaw Poland in Mil Hosp, Dept Cardiol, Wroclaw, Poland Max Delbruck Ctr Mol Med, Charite, Franz Volhard Klin, Berlin, Germany MaxDelbruck Ctr Mol Med Berlin Germany z Volhard Klin, Berlin, Germany
Titolo Testata:
CIRCULATION
fascicolo: 5, volume: 104, anno: 2001,
pagine: 544 - 549
SICI:
0009-7322(20010731)104:5<544:PCH-AO>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
BAROREFLEX SENSITIVITY; RATE-VARIABILITY; VENTILATORY RESPONSE; CARDIOVASCULAR MORTALITY; MYOCARDIAL-INFARCTION; BLOOD-PRESSURE; REFLEX CONTROL; CHEMOSENSITIVITY; EXERCISE; CHEMOREFLEX;
Keywords:
peripheral chemoreceptors; heart failure; baroreceptors; prognosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
30
Recensione:
Indirizzi per estratti:
Indirizzo: Ponikowski, P Natl Heart & Lung Inst, Clin Cardiol, Dovehouse St, London SW3 6LY, England Natl Heart & Lung Inst Dovehouse St London England SW3 6LY
Citazione:
P. Ponikowski et al., "Peripheral chemoreceptor hypersensitivity - An ominous sign in patients with chronic heart failure", CIRCULATION, 104(5), 2001, pp. 544-549

Abstract

Background-Peripheral chemoreceptor hypersensitivity is a feature of abnormal cardiorespiratory reflex control in chronic heart failure (CHF) and maycontribute 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 (V) over dot o(2)] 18+/-7 mL(-1) . min(-1)). CHF patients demonstrated augmented peripheral chemosensitivity and decreased BRS (all P<0.01 versus reference values). During follow-up (median 41 months, >3 years in all survivors), 37 patients died. High peripheral chemosensitivity (>0.72 L. min(-1) . %Sao(2)(-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% Cl 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 (V) over dot o(2), and (V) over dot E/(V) over dot CO2 [P=0.002]; hazard ratio 2.6, 95% CI 1.3 to 5.1, adjusted for age, LVEF, and peak (V) over dot O-2 [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, maybe the reason for the previously observed prognostic association of the latter.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/01/20 alle ore 16:16:01