Combined Increased Chemosensitivity to Hypoxia and Hypercapnia as a Prognosticator in Heart Failure

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:53

Article

Giannoni, Alberto^2,3,4,5  Emdin, Michele^1,2  Bramanti, Francesca²  Iudice, Giovanni²  Francis, Darrel P.^4,5  Barsotti, Antonio³  Piepoli, Massimo⁶  Passino, Claudio⁷ 

[1] G Monasterio Fdn, Dept Cardiovasc Med, CNR Reg Toscana, I-56124 Pisa, Italy

[2] CNR, Inst Clin Physiol, I-56100 Pisa, Italy

[3] Univ Genoa, Dept Cardiol, Genoa, Italy

[4] St Marys Hosp, Int Ctr Circulatory Hlth, London, England

[5] Univ London Imperial Coll Sci Technol & Med, London, England

[6] G da Saliceto Polichirurg Hosp, Heart Failure Unit, Dept Cardiol, Piacenza, Italy

[7] Scuola Super Sant Anna, Pisa, Italy

关键词: heart failure;    prognosis;    chemoreflex;    arrhythmia;    brain natriuretic peptide;    Cheyne-Stokes respiration;   

DOI  :  10.1016/j.jacc.2009.02.030

来源: Elsevier

【 摘 要 】

Objectives The aim of the present study was to investigate the prognostic significance of chemosensitivity to hypercapnia in chronic heart failure (HF). Background Increased chemosensitivity to hypoxia and hypercapnia has been observed in HF. The potential value of enhanced chemosensitivity to hypercapnia to risk prediction in systolic HF has not been specifically evaluated. Methods One hundred ten consecutive systolic HF patients (age 62 +/- 15 years, left ventricular ejection fraction [LVEF] 31 +/- 7%) underwent assessment of chemosensitivity to hypoxia and hypercapnia (rebreathing technique) and were followed up for a median period of 29 months (range 1 to 54 months). The end point was a composite of cardiac death and aborted cardiac death (ventricular tachyarrhythmia treated by cardioverter-defibrillator). Results At baseline, 31 patients (28%) had enhanced chemosensitivity to both hypoxia and hypercapnia. Although they had the same LVEF as the 43 patients (39%) with normal chemosensitivity, they were more symptomatic (New York Heart Association functional class), had higher plasma brain natriuretic peptide and norepinephrine, steeper regression slope relating minute ventilation to carbon dioxide output (VE/VCO(2) slope), more Cheyne-Stokes respiration, and more ventricular arrhythmias (all p < 0.05). Four-year survival was only 49%, in marked contrast to 100% for patients with normal chemosensitivity (p < 0.001). On multivariate analysis, combined elevation in chemosensitivity was the strongest independent prognostic marker, even when adjusted for univariate predictors (VE/VCO(2) slope, Cheyne-Stokes respiration, LVEF, and brain natriuretic peptide, p < 0.05). Conclusions Increased chemosensitivity to both hypoxia and hypercapnia, eliciting neurohormonal derangement, ventilation instability, and ventricular arrhythmias, is a very serious adverse prognostic marker in HF. (J Am Coll Cardiol 2009; 53: 1975-80) (C) 2009 by the American College of Cardiology Foundation

【 授权许可】

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