Abstract 19039: Prediction of the Chemoreflex Sensitivity by Common Clinical Variables in Systolic Heart Failure
Background: Increased peripheral and central chemoreflex sensitivity, as assessed by the hypoxic or hypercapnic ventilatory response (HVR and HCVR, respectively) are two key determinants of heart failure (HF) progression leading to adrenergic activation, arrhythmias and cardiac mortality, thus making them potential therapeutic targets. Their assessment is however technically demanding and uncomfortable for HF patients. Therefore, to increase the awareness of the chemoreflex gain in a clinical scenario, we tried to define a model of chemoreflex prediction starting from standard biohumoral and instrumental variables.
Methods and results: 191 patients with stable systolic HF (left ventricular ejection fraction - LVEF - <50%) underwent chemoreflex assessment by rebreathing technique to calculate both HVR and HCVR. All patients underwent clinical and neurohormonal evaluation, echocardiography, cardiopulmonary exercise test (CPET) and a daytime cardiorespiratory monitoring for breathing pattern evaluation. Regarding HVR, multivariate penalized, Bayesian Model Averaging (BMA) and random forests trees identified, as predictors, the presence of periodic breathing and increase slope of the relation between ventilation and carbon dioxide production (VE/VCO2) during exercise, with a 71% out of bag accuracy. HCVR was instead predicted by plasma levels of N-terminal fragment of proBNP (NT-proBNP) and VE/VCO2, with a 58% out of bag accuracy.
Conclusions: simply using a blood withdrawal, a short term daytime recording and a CPET is possible to accurately predict the chemosensitivity to hypoxia and hypercapnia in HF patients. Our model might easily allow the identification of patients who may benefit from the knowledge of the chemoreflex status, without actually performing a chemoreflex test, in order to improve risk assessment and possibly select candidate to chemoreflex modulation strategies.
Author Disclosures: G. Mirizzi: None. A. Ripoli: None. A. Giannoni: None. G. Vergaro: None. F. Bramanti: None. G. Iudice: None. V. Raglianti: None. A. Aimo: None. M. Emdin: None. C. Passino: None.
- © 2014 by American Heart Association, Inc.