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(Circulation. 1997;96:2586-2594.)
© 1997 American Heart Association, Inc.
Articles |
Augmented Peripheral Chemosensitivity as a Potential Input to Baroreflex Impairment and Autonomic Imbalance in Chronic Heart Failure
From the Department of Cardiac Medicine (P.P., T.P.C., M.P., D.O., K.W.-P., D.H., S.D.A., A.J.S.C.), Imperial College School of Medicine, National Heart and Lung Institute, London, UK, and Centro Medico di Gussago (M.V., A.G.) and Centro Medico di Veruno (R.C., G.M.), Fondazione "Salvatore Maugeri," Italy.
Correspondence to Prof Andrew J.S. Coats, Department of Cardiac Medicine, National Heart and Lung Institute, Dovehouse St, London SW3 6LY, UK.
Background The precise mechanisms responsible for the sympathetic overactivity and blunted baroreflex control in chronic heart failure (CHF) remain obscure. Augmented peripheral chemosensitivity has recently been demonstrated in CHF. We evaluated the relation between peripheral chemoreflex sensitivity and autonomic activity in patients with CHF.
Methods and Results We studied in 26 stable patients with
CHF the peripheral chemosensitivity (ventilatory response
to hypoxia using transient inhalations of pure nitrogen),
autonomic balance (spectral analysis of heart rate variability
[HRV]), and baroreflex sensitivity (bolus phenylephrine
method and 
index). To determine whether transient inactivation of
peripheral chemoreceptors might influence autonomic
balance, 12 patients underwent a second study during which they
breathed 100% O2. Peripheral chemosensitivity
correlated inversely with HRV power within the low-frequency band (0.04
to 0.15 Hz) (r=-.52, P=.006) and inversely with
baroreflex sensitivity (r=-.60, P=.005). When
the patients were divided into two groups according to the
chemosensitivity of age-matched normal controls (above and below mean+2
SDs of chemosensitivity of control subjects), those above the normal
range revealed more impaired autonomic balance, ie, lower baroreflex
sensitivity (1.4±1.3 versus 5.0±1.5 ms/mm Hg, P<.0001)
and depressed values of low-frequency power (2.5±1.8 versus 4.1±0.8
ln ms2, P<.005) compared with those with normal
chemosensitivity. Transient hyperoxia did not alter heart rate or
systolic pressure but resulted in an increase in HRV and an
improvement in baroreflex sensitivity.
Conclusions A link between increased peripheral chemosensitivity and impaired autonomic control, including baroreflex inhibition, is demonstrated. The clinical importance of this phenomenon warrants further investigation.
Key Words: heart failure • autonomic function • chemoreceptors • baroreceptors
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