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(Circulation. 2001;104:2324.)
© 2001 American Heart Association, Inc.

Clinical Investigations and Reports

Muscle Ergoreceptor Overactivity Reflects Deterioration in Clinical Status and Cardiorespiratory Reflex Control in Chronic Heart Failure

Piotr P. Ponikowski, MD; Tuan P. Chua, MD; Darrel P. Francis, MRCP; Alessandro Capucci, MD; Andrew J.S. Coats, DM; Massimo F. Piepoli, MD PhD

From Clinical Cardiology, Imperial College School of Medicine at the NHLI, London, UK (P.P.P., T.P.C., D.P.F., A.J.S.C., M.F.P.); Cardiology Department, Military Hospital, Wroclaw, Poland (P.P.P.); and Cardiology Division, General Hospital, Piacenza, Italy (M.F.P., A.C.).

Correspondence to Massimo Piepoli, MD, PhD, Clinical Cardiology, Heart Failure Unit, Royal Brompton Hospital, Sydney St, London, SW3 6LY, UK. E-mail m.piepoli{at}ic.ac.uk

Background— In chronic heart failure (CHF), overactivation of ergoreceptors (afferents sensitive to the metabolic effects of muscular work) may be a link between peripheral changes, sympathetic overactivation, and increased hemodynamic and ventilatory responses to exercise. The relationship between ergoreceptors, autonomic changes, and the progression of the syndrome has not yet been studied.

Methods and Results— Thirty-eight stable CHF patients (age, 57±1 years; ejection fraction, 26±2%) were compared with 12 age-matched normal control subjects. The ergoreflex contribution to the ventilatory and hemodynamic responses to exercise, together with peripheral and central chemoreceptor sensitivity, arterial baroreflex sensitivity, plasma norepinephrine, epinephrine, and heart rate variability, were measured. Enhanced ergoreflex effects on ventilation (78±2% versus 50±8%), peripheral chemosensitivity (0.6±0.4 versus 0.2±0.1 L/min per percent SaO₂), and central chemosensitivity (2.9±0.2 versus 2.0±0.2 L · min^-1 · mm Hg^-1) and an impaired baroreflex function (4.1±0.6 versus 9.1±5.6 ms/mm Hg) were confirmed in CHF compared with control subjects (P<0.01 in all comparisons). Ergoreceptor overactivity was associated with a worse symptomatic state (NYHA class, P<0.05), lower exercise tolerance (peak VO₂, P<0.05), and pronounced exercise hyperventilation (E/VCO₂, P<0.01). It was also a strong predictor of increased central chemosensitivity (independently of clinical parameters), baroreflex impairment, and sympathetic activation (plasma catecholamines and heart rate variability indexes; all P<0.05). In multivariate analysis, among all reflexes studied, the ventilatory component of the ergoreflex was the only independent predictor of peak VO₂ and E/VCO₂.

Conclusions— In CHF, overactivation of the ergoreflex is associated with abnormal cardiorespiratory reflex control, independently of clinical severity. Among impaired reflexes, overactivation of the ergoreflex is an important determinant of exercise hyperventilation and reduced exercise tolerance.

Key Words: baroreflex • chemosensitivity • ventilation • exercise

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