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

Giannoni, Alberto; Emdin, Michele; Bramanti, Francesca; Iudice, Giovanni; Francis, Dárrel P.; Barsotti, Antonio; Piepoli, Massimo F; Passino, Claudio

doi:10.1016/j.jacc.2009.02.030

Cited by 135 publications

(153 citation statements)

References 25 publications

(28 reference statements)

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“…In patients with heart failure, increased chemosensitivity and consequent ventilatory oscillations are harbingers of the neurohumoral derangement that ultimately predisposes to mortality (42,43). On this basis, a simple means to quantify reduced stability, as distinct from increased biological noise, may have clinical usefulness.…”

Section: Discussionmentioning

confidence: 99%

Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure

Sands

Mebrate

Edwards

et al. 2017

Am J Respir Crit Care Med

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Rationale: In patients with chronic heart failure, daytime oscillatory breathing at rest is associated with a high risk of mortality. Experimental evidence, including exaggerated ventilatory responses to CO 2 and prolonged circulation time, implicates the ventilatory control system and suggests feedback instability (loop gain . 1) is responsible. However, daytime oscillatory patterns often appear remarkably irregular versus classic instability (Cheyne-Stokes respiration), suggesting our mechanistic understanding is limited.Objectives: We propose that daytime ventilatory oscillations generally result from a chemoreflex resonance, in which spontaneous biological variations in ventilatory drive repeatedly induce temporary and irregular ringing effects. Importantly, the ease with which spontaneous biological variations induce irregular oscillations (resonance "strength") rises profoundly as loop gain rises toward 1. We tested this hypothesis through a comparison of mathematical predictions against actual measurements in patients with heart failure and healthy control subjects.Methods: In 25 patients with chronic heart failure and 25 control subjects, we examined spontaneous oscillations in ventilation and separately quantified loop gain using dynamic inspired CO 2 stimulation.Measurements and Main Results: Resonance was detected in 24 of 25 patients with heart failure and 18 of 25 control subjects. With increased loop gain-consequent to increased chemosensitivity and delay-the strength of spontaneous oscillations increased precipitously as predicted (r = 0.88), yielding larger (r = 0.78) and more regular (interpeak interval SD, r = 20.68) oscillations (P , 0.001 for all, both groups combined).Conclusions: Our study elucidates the mechanism underlying daytime ventilatory oscillations in heart failure and provides a means to measure and interpret these oscillations to reveal the underlying chemoreflex hypersensitivity and reduced stability that foretells mortality in this population.Keywords: instability; loop gain; Cheyne-Stokes respiration; heart failure; chemosensitivity

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Section: Discussionmentioning

confidence: 99%

Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure

Sands

Mebrate

Edwards

et al. 2017

Am J Respir Crit Care Med

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“…Sympathetic nerve system activation is an invariant response to pathological respiratory chemoreflex activation [25], and sustained Fig. 1 The left plot shows the negative association between LTL and e-LFCNB, and the right plot shows the negative association between e-LFCNB and HFC sympathoexcitation [26] may be a plausible explanation for the rise in e-LFCNB during sleep. Another plausible explanation of the association may be the sleep fragmentation itself, which can induce hypertension, insulin resistance and metabolic dysregulation [24,[27][28][29].…”

Section: Discussionmentioning

confidence: 95%

The association between leukocyte telomere lengths and sleep instability based on cardiopulmonary coupling analysis

et al. 2015

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“…Enhanced CO 2 chemosensitivity occurs in HF 36 and correlates with sympathetic activation 37 and natriuretic peptide elevation 38,39 as well as HF mortality. 38 Augmented chemosensitivity also promotes hyperventilation with reduction of CO 2 concentration below the apneic threshold, thereby causing compensatory and cyclic hypopnea or apnea characteristic of CSA.…”

Section: Lavi and Co 2 Chemosensitivitymentioning

confidence: 99%

“…38 Augmented chemosensitivity also promotes hyperventilation with reduction of CO 2 concentration below the apneic threshold, thereby causing compensatory and cyclic hypopnea or apnea characteristic of CSA. 25,26,40,41 Consistent with prior studies, 25,26,40 we observed that CO 2 chemosensitivity is augmented in patients with HF with CSA.…”

Section: Lavi and Co 2 Chemosensitivitymentioning

confidence: 99%

Left Atrial Size, Chemosensitivity, and Central Sleep Apnea in Heart Failure

Calvin

Somers

Johnson

et al. 2014

Chest

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

Abstract: Increased chemosensitivity to both hypoxia and hypercapnia, eliciting neurohormonal derangement, ventilation instability, and ventricular arrhythmias, is a very serious adverse prognostic marker in HF.

Cited by 135 publications

References 25 publications

Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure

Resonance as the Mechanism of Daytime Periodic Breathing in Patients with Heart Failure

The association between leukocyte telomere lengths and sleep instability based on cardiopulmonary coupling analysis

Left Atrial Size, Chemosensitivity, and Central Sleep Apnea in Heart Failure

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