Clinical significance of chemosensitivity in chronic heart failure: influence on neurohormonal derangement, Cheyne-Stokes respiration and arrhythmias

Alberto Giannoni , Michele Emdin , Roberta Poletti , Francesca Bramanti , Concetta Prontera , Massimo Piepoli , Claudio Passino (1)

1 Institute of Clinical Physiology

Increased chemosensitivity has been observed in heart failure (HF). To investigate its pathophysiological and clinical relevance, we evaluated its impact on neurohormonal balance, breathing pattern, response to exercise, and arrhythmic profile. Sixty patients with chronic HF (age 66±1 years, left ventricular ejection fraction, EF, 31±1%, mean±SEM) underwent assessment of hypoxic-normocapnic (HVR) and hypercapnic-normoxic ventilatory response (HCVR), neurohormonal evaluation, cardiopulmonary test, 24 h electrocardiographic monitoring assessment of Cheyne-Stokes respiration (CSR) by diurnal and nocturnal polygraphy. Sixty percent of patients had enhanced chemoceptive sensitivity. Those with enhanced chemosensitivity to both hypoxia and hypercapnia, as compared to those with normal chemosensitivity, showed significantly (P<0.01) higher norepinephrine and B-type natriuretic peptide level, higher prevalence of day-time and night-time CSR, worse NYHA class and ventilatory efficiency (higher VE/VCO 2} slope), and higher incidence of chronic atrial fibrillation and paroxysmal nonsustained ventricular tachycardia, but no difference in left ventricular volumes or EF. A direct correlation was found between HVR or HCVR and norepinephrine (R= 0.40 and R= 0.37, respectively, P< 0.01), BNP (R= 0.40, P< 0.01), NT-proBNP (R= 0.37 and R= 0.41, P< 0.01), apnoea-hypopnoea index (R= 0.57 and R= 0.59, P< 0.001) and VE/VCO 2} slope (R= 0.42 and R= 0.50, respectively, P< 0.001). Finally, at multivariate analysis, HCVR was an independent predictor of day-time and night-time CSR. In conclusion, increased chemosensitivity to hypoxia and hypercapnia, particularly when combined, is associated with neurohormonal impairment, worse ventilatory efficiency, CSR, and higher incidence of arrhythmias, and is likely to play a central pathophysiological role in HF patients.

Mots clés: Medicine

Alberto Giannoni, Michele Emdin, Roberta Poletti, Francesca Bramanti, Concetta Prontera, et al.. Clinical significance of chemosensitivity in chronic heart failure: influence on neurohormonal derangement, Cheyne-Stokes respiration and arrhythmias. Clinical Science, 2007, 114 (7), pp.489-497. ⟨10.1042/CS20070292⟩. ⟨hal-00479397⟩