Clinical Predictors and Hemodynamic Consequences of Elevated Peripheral Chemosensitivity in Optimally Treated Men With Chronic Systolic Heart Failure

Niewiński, Piotr; Engelman, Zoar J.; Fudim, Marat; Tubek, Stanisław; Paleczny, Bartłomiej; Jankowska, Ewa A.; Banasiak, Waldemar; Sobotka, Paul; Ponikowski, Piotr

doi:10.1016/j.cardfail.2013.03.013

Cited by 45 publications

(80 citation statements)

References 35 publications

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“…The CB mediated peripheral chemoreflex is enhanced in patients with essential HTN 24, 25 and animal models of HTN 26 , as sympathetic tone is 27, 28 . Indeed, peripheral chemoreceptor reflex has been shown to be elevated in other sympathetically mediated diseases in humans, like CHF 10, 29 . In animal models of HTN 4, 7, 30 there is compelling evidence for a CB contribution to cardiovascular control.…”

Section: Discussionmentioning

confidence: 99%

Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients

Fudim

Groom

Laffer

et al. 2015

Journal of the American Society of Hypertension

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Removal of the carotid body (CB) improves animal models of hypertension (HTN) and heart failure, presumably via withdrawal of chemoreflex-induced sympathetic activation. The effect of CB tumor (CBT) resection on blood pressure (BP) in subjects with HTN is unknown. We conducted a retrospective analysis of 20 subjects with HTN (BP≥140/90 mmHg or use of antihypertensives) out of 134 who underwent CBT resection. Short-term (from 3 months before to the first reading after 30 days from surgery) and long-term (slope of the regressions on time over the entire follow up) changes in BP and heart rate (HR) were ascertained and adjusted for covariates (interval between readings, total follow up, number of readings and changes in therapy). Age and duration of HTN were 56±4 and 9±5 years. Adjusted short-term decreases in systolic (SBP: −9.9±3.1, p<0.001) and pulse pressures (PP: −7.9±2.7, p<0.002) were significant and correlated with their respective long-term changes (SBP: r=0.47, p=0.047; PP: r=0.54, p=0.019). Also, there was a strong relationship between adjusted short-term changes in SBP and PP (r=0.64, p<0.004). Out of 12 subjects with concordant decreases in short-and long-term BP changes, 6 (50% of responders or 33% of the total) had short-term falls of SBP ≥10 mmHg and of PP ≥ 5mmHg. To our knowledge this study is the first to show that unilateral CBT resection is associated with sustained reduction of BP in subjects with HTN. Hence, we suggest that targeted removal of the CB chemoreflex conceivably has a role in the therapy of human HTN.

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Section: Discussionmentioning

confidence: 99%

Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients

Fudim

Groom

Laffer

et al. 2015

Journal of the American Society of Hypertension

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“…Increased chemosensitivity to hypoxia and hypercarbia could be a mechanism of acute and chronic sympathetic stimulation with subsequent decrease in splanchnic vascular capacitance (Figure ) . Patients with HF have an increased sensitivity of the peripheral chemoreceptors, leading to exaggerated responses in respiratory drive and sympathetically mediated blood pressure increases to hypoxic stimulation . Moreover, peripheral chemoreceptor hypersensitivity was found to be an independent predictor of mortality in patients with HF .…”

Section: Clinical Evidence For Impaired Splanchnic Capacitancementioning

confidence: 99%

Role of Volume Redistribution in the Congestion of Heart Failure

Fudim

Hernandez

Felker

2017

JAHA

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“…; Niewinski et al . ) for the most commonly employed assessment methods. When using the above definition, the prevalence of augmented PChS in HF population is estimated at 40–44%.…”

Section: Introductionmentioning

confidence: 99%

Carotid body modulation in systolic heart failure from the clinical perspective

Niewiński¹

2016

The Journal of Physiology

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Augmented sensitivity of peripheral chemoreceptors (PChS) is a common finding in systolic heart failure (HF). It is related to lower left ventricle systolic function, higher plasma concentrations of natriuretic peptides, worse exercise tolerance and greater prevalence of atrial fibrillation compared to patients with normal PChS. The magnitude of ventilatory response to the activation of peripheral chemoreceptors is proportional to the level of heart rate (tachycardia) and blood pressure (hypertension) responses. All these responses can be measured non-invasively in a safe and reproducible fashion using different methods employing either hypoxia or hypercapnia. Current interventions aimed at modulation of peripheral chemoreceptors in HF are focused on carotid bodies (CBs). There is a clear link between afferent signalling from CBs and sympathetic overactivity, which remains the priority target of modern HF treatment. However, CB modulation therapies may face several potential obstacles: (1) As evidenced by HF trials, an excessive inhibition of sympathetic system may be harmful. (2) Proximity of critical anatomical structures (important vessels and nerves) makes surgical and transcutaneous interventions on CB technically demanding. (3) Co-existence of atherosclerosis in the area of carotid artery bifurcation increases the risk of central embolic events related to CB modulation. (4) The relative contribution Piotr Niewinski is clinical scientist and active cardiologist specializing in heart failure and invasive electrophysiology. He received his PhD from Wroclaw Medical University in 2015 for his research focused on pathophysiology of peripheral chemoreceptors in systolic heart failure. He was involved in first-in-man trials of carotid body modulation. He is a member of the Polish Society of Cardiology and European Society of Cardiology.This review was presented at the meeting of International Society for Autonomic Neuroscience, which took place in Stresa, Italy on 27 September 2015. of CBs vs. aortic bodies to sympathetic activation in HF patients is unclear. (5) Choosing optimal candidates for CB modulation from the population of HF patients may be problematic. (6) There is a risk of nocturnal hypoxia following CB ablation -mostly after bilateral procedures and in patients with concomitant obstructive sleep apnoea. Abstract figure legend Potential risk and benefits of carotid body modulation in systolic heart failure.Abbreviations AB, aortic body; CB, carotid body; HF, heart failure; HR, heart rate; HVR, hypoxic ventilatory response; P aCO2 , partial pressure of carbon dioxide in arterial blood; P aO2 , partial pressure of oxygen in arterial blood; PChR, peripheral chemoreceptors; PChS, peripheral chemosensitivity; SBP, systolic blood pressure; S pO2 , peripheral capillary oxygen saturation.

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Clinical Predictors and Hemodynamic Consequences of Elevated Peripheral Chemosensitivity in Optimally Treated Men With Chronic Systolic Heart Failure

Cited by 45 publications

References 35 publications

Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients

Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients

Role of Volume Redistribution in the Congestion of Heart Failure

Carotid body modulation in systolic heart failure from the clinical perspective

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